Psych past paper (16-21)

Question 1

A 72 year old man has a 6 month history of low mood, poor sleep and poor appetite. His wife died 1 year ago. He complains of poor memory, forgetting to take his medication and forgetting appointment dates and neglecting to pay bills. He used to attend the community centre but no longer enjoys doing so. He feels hopeless about the future. He denies suicidal ideation. Which is the most likely diagnosis?

a. Abnormal grief reaction
b. Adjustment disorder with depressed mood
c. Alzheimer’s disease
d. Severe depressive episode without psychotic features
e. Vascular dementia

Answer 1

d. Severe depressive episode without psychotic features

Question 2

A 28 year old man attends the clinic with his mother. He states that he has ‘had enough’ because his flatmates are Russian spies who are after him, follow him wherever he goes and he can hear them comment on his actions when they are not in the room with him. As a result of this, he has stopped going out and has limited his contact with his family and friends in recent months. Which of the features described is a negative symptom?

a. He believes that he is being followed
b. He believes that his flatmates are Russian spies
c. He has limited social contacts
d. He hears the voices of his flat mates
e. His flatmates’ voices comment on his actions

Answer 2

c. He has limited social contacts

Question 3

A 35 year old man has been feeling low in mood and has disturbed sleep. He has been taking fluoxetine 40 mg daily for 3 months, with no improvement. His treating doctor intends to commence him on citalopram 20 mg daily. Which is the most appropriate next step in regards to changing his medication?

a. Add citalopram to fluoxetine at the current dose, withdrawing fluoxetine only if patient’s syndrome improve
b. Cross taper, i.e. reduce the fluoxetine dose, simultaneously adding citalopram
c. Reduce fluoxetine dose to 20mg daily, discontinue it after 1 week and then immediately initiate citalopram
d. Reduce fluoxetine dose to 20mg daily and start citalopram after a 1 week washout period
e. Reduce fluoxetine dose to 20 mg daily and start citalopram after a 6 week washout period

Answer 3

d. Reduce fluoxetine dose to 20mg daily and start citalopram after a 1 week washout period

Question 4

An 18 year old woman has not eaten any solid food over the past week and has been limiting her liquid intake to 500 mL per day. She is preoccupied about being significantly overweight. Which blood test parameter is most likely to be raised in this scenario?

a. Cholesterol
b. Haemoglobin
c. Phosphate
d. Potassium
e. Triiodothyronine (T3)

Answer 4

a. Cholesterol

Question 5

A 46 year old woman attends a follow up appointment with the community mental health team. She has been taking venlafaxine 150mg daily for the past 3 months. She is feeling more energetic, requiring very little sleep, has been going out most evenings and is overspending. Which is the most appropriate next step in regards to her management?

a. Refer to the community mental health team
b. Start lithium
c. Start risperidone
d. Start sodium valproate
e. Stop venlafaxine

Answer 5

e. Stop venlafaxine

Question 6

A 30 year old woman is admitted to the mental health unit from the Emergency Department. She appears elated, apparently unconcerned that she has hardly slept in recent days and is talking about flying to the USA to assume the presidency. She was reported by her companion to have eaten soap. Her past psychiatric and medical history is unremarkable. Which is the most appropriate pharmacological intervention for this acute presentation?

a. Carbamazepine
b. Lithium
c. Olanzapine
d. Sertraline
e. Sodium valproate

Answer 6

c. Olanzapine

Question 7

The family of a 72 year old man have raised concerns about his memory, which has recently deteriorated. He has had a number of similar presentations over the past 3 years. Following each episode, his ability to communicate and care for himself has declined. His medical history includes diabetes, hypertension, hyperlipidaemia and transient ischaemic attacks. Which is the most likely diagnosis?

a. Alzheimer’s disease
b. Creutzfeld-Jakob disease
c. Frontotemporal dementia
d. Lewy body dementia
e. Vascular dementia

Answer 7

e. Vascular dementia

Question 8

A 20 year old woman attends the outpatient clinic following concerns by her GP about her eating habits. She significantly restricts her food intake and induces vomiting when she feels that she has overeaten. She speaks a lot about food and has started baking cakes, although she does not appear to eat them. She has not had a period for over 3 months. Her BMI is 18.5 kg/m2. She appears anxious when her diet is discussed. Which presenting feature most characteristically indicates a diagnosis of anorexia nervosa?

a. Amenorrhoea
b. Anxiety when discussing food
c. BMI of 18.5 kg/m2
d. Preoccupation with food
e. Purging behaviour

Answer 8

d. Preoccupation with food

Question 9

A 30 year old woman with type I diabetes mellitus has developed end-stage renal failure and requires dialysis. She believes that the hospital (where she is admitted) has conspired to intentionally give her diabetes. She is therefore refusing to have dialysis and is actively attempting to leave the hospital. She is able to retain the relevant information and communicate her decision to refuse dialysis, which she justifies based on her thoughts that dialysis will cause her further harm. Blood investigations: potassium 6.7 mmol/L (3.5 - 5.3), Urea 50 mmol/L (2.5 - 7.8), creatinine 1200 micromol/L (60 - 120). Which is the most appropriate next step in regards to her management?

a. Detain the patient under Section 5(2) of the Mental Health Act and provide emergency dialysis
b. Facilitate a Mental Health Act assessment
c. Facilitate an urgent best interests assessment
d. Facilitate dialysis under common law, using sedation if required
e. Facilitate discharge and continue discussions with the patient in the community

Answer 9

b. Facilitate a Mental Health Act assessment

Question 10

A 27 year old woman with diabetes reports not sleeping for 1 week. She has recently ended her relationship with her partner of 5 years because she believes that he is a member of the CIA and has been uncharacteristically promiscuous. She states that she hears his voice even when she is not with him in the room. Which medication combination is most appropriate in this scenario?

a. Aripiprazole and sodium valproate
b. Clozapine and lithium
c. Olanzapine and carbamazepine
d. Quetiapine and lithium
e. Risperidone and lamotrigine

Answer 10

d. Quetiapine and lithium

Question 11

A 35 year old woman is referred to the mental health nurse based in her GP surgery, following multiple presentations over the last year with gynaecological symptoms. She has a regular menstrual cycle, but with the onset of menstruation, she becomes increasingly anxious that she has developed life-threatening internal bleeding. She is worried that she may have cancer of the uterus. Blood tests, including a full blood count, are within normal limits. Her blood pressure is normal. Which is the most likely diagnosis?

a. Conversion disorder
b. Factitious disorder
c. Hypochondrial disorder
d. Malingering
e. Somatisation disorder

Answer 11

c. Hypochondrial disorder

Question 12

A 19 year old woman writes to her new GP to profess her love for him. In the letter, she describes her belief that they are destined to marry, which she knew to be true after seeing his picture on the surgery’s website. Police have been contacted by her GP after she was seen to be following him home late at night. Which is the most likely diagnosis?

a. Acute stress reaction
b. De Clerambault syndrome (erotomanic delusions)
c. Emotionally unstable personality disorder
d. Normal adolescent development
e. Schizophrenia

Answer 12

b. De Clerambault syndrome (erotomanic delusions)

Question 13

A 50 year old man has been feeling low in mood and describes ‘not enjoying anything’ in recent weeks. He has difficulties concentrating at work, where his performance has been declining. He is unkempt and losing weight. He has seen his GP who initiated sertraline 100mg daily 1 month ago and referred him to the community mental health team. Which is the most appropriate next step in his management?

a. Add lithium
b. Add mirtazapine
c. Add olanzapine
d. Increase the dose of sertraline
e. Switch to dosulepin (a TCA)

Answer 13

d. Increase the dose of sertraline

Question 14

A 19 year old university student presents with a 3 week history of thinking that MI6 are out to get him. He believes that he is being monitored and checks his locks up to 20 times per day. He last used cannabis 3 years ago. At present he is euthymic. Which is the most likely diagnosis?

a. Acute psychotic disorder
b. Delusional disorder
c. Obsessive compulsive disorder
d. Paranoid schizophrenia
e. Schizoaffective disorder

Answer 14

a. Acute psychotic disorder

Question 15

A 28 year old man is prescribed regular medication for bipolar disorder. He has also been taking naproxen for a sports injury. He presents to the Emergency Department with ataxia, confusion and tremor. Which medication is most likely to have resulted in his symptoms?

a. Carbamazepine
b. Lithium
c. Olanzapine
d. Sertraline
e. Sodium valproate

Answer 15

lithium

Question 16

A 25 year old woman is currently an informal inpatient on a mental health ward for management of a depressive episode. She has intent to end her life. She wants to leave the ward. She is deemed to have capacity to make a decision to leave hospital. Which is the next most appropriate step in management?

a. Allow her to self discharge
b. Detain her under the Deprivation of Liberty Safeguards
c. Detain her under the Mental Capacity Act
d. Detain her under the Section 2 of the Mental Health Act
e. Detain her under the Section 5(2) of the Mental Health Act

Answer 16

e. Detain her under the Section 5(2) of the Mental Health Act

Question 17

A 85 year old man in the memory clinic has concerns about being unable to recall what he ate for breakfast that morning or provide detail regarding his activities today and yesterday. He has difficulties concentrating. He has a tremor and poor balance. Which is the most appropriate initial step in his work-up?

a. Blood tests
b. CT brain
c. MoCA (Montreal Cognitive Assessment)
d. MRI brain
e. Neuropsychological testing

Answer 17

c. MoCA (Montreal Cognitive Assessment)

?????

Question 18

A 22 year old woman in the Emergency Department describes an episode when she saw an unfamiliar man in her house at sunset. Her boyfriend, who was with her at the time, did not see this man in her house, but noted that she was disoriented to time and place. She reported no other difficulties at the time and she has no previous psychiatric history. Her AMTS is 6/10 and her temperature 37.9C. Investigations: GGT 11 IU/L (9 - 40), CRP 70 mg/L (<5); urine drug screen - negative for all substances. Which is the most likely diagnosis?

a. Alcoholic hallucinosis
b. Delirium
c. First episode psychotic disorder
d. Temporal lobe epilepsy
e. Young onset dementia

Answer 18

b. Delirium

Question 19

A 48 year old woman with Down syndrome has worsening memory impairment which is affecting her activities of daily living. Which is the most likely diagnosis?

a. Alzheimer’s disease
b. Frontotemporal dementia
c. Lewy body dementia
d. Pseudodementia
e. Vascular dementia

Answer 19

a. Alzheimer’s disease

Question 20

A 30 year old woman is assessed at the addictions treatment clinic for her heroin addiction, having never had treatment previously. Which is the most appropriate pharmacological treatment to initiate?

a. Diazepam
b. Disulfiram
c. Methadone
d. Naloxone
e. Naltrexone

Answer 20

c. Methadone

Question 21

A 30 year old woman attends the Urgent Treatment Centre after cutting her wrists superficially. She suffers from depression and is taking sertraline 50mg daily. Her partner walked out on her this morning. She feels distressed but her sister has offered to stay with her. She has previously cut her wrists with no threat to her life. She has no thoughts of suicide. She intends to attend her appointment with the psychiatrist tomorrow. Which is the next most appropriate step in management?

a. Arrange a Mental Health Act assessment
b. Call an ambulance
c. Call the duty psychiatrist for an urgent assessment
d. Give her the 24 hour mental health crisis number
e. Increase her dose of sertraline

Answer 21

c. Call the duty psychiatrist for an urgent assessment

Or is it D because she says she’s not at risk

Question 22

A 24 year old paramedic is referred to see a psychiatrist by her GP. She reports that she has not been herself after attending a call last month when the patient ultimately died. She complains of low mood and difficulty falling asleep on most nights. Her appetite is not affected and she has not lost any weight. Blood test results including full blood count and thyroid function tests are unremarkable. Which is her most likely diagnosis?

a. Acute stress reaction
b. Adjustment disorder
c. Depressive episode
d. Generalised anxiety disorder
e. Post-traumatic stress disorder

Answer 22

Acute stress reaction

Question 23

A 25 year old man in the outpatient clinic is asked what prompted his GP to refer him. He responds as follows: ‘Doctor, that’s a difficult question. When I woke up at 7am, I thought about how much I’d like to make myself a boiled egg. I watched the news for a bit, and then found my favourite leather shoes. Later on I popped over to Tesco to get some fruit, and after that I came here to discuss a change in my medication’. Which thought disorder is exhibited by the man in this scenario?

a. Circumstantiality
b. Derailment (loosening of associations)
c. Flight of ideas
d. Pressure of speech
e. Tangentiality

Answer 23

a. Circumstantiality

Question 24

A 44 year old man has a 10 year history of using crack cocaine and heroin. He uses both substances once or twice per week and often feels depressed following episodes of excessive use. He developed hepatitis C after sharing needles. He does not describe a strong desire to use these substances, but nonetheless continues to do so. Which diagnosis best describes his presentation?

a. Acute intoxication
b. Dependence
c. Depressive disorder
d. Harmful use
e. Withdrawal syndrome

Answer 24

b. Dependence

Question 25

A 35 year old man in General Practice has obsessive compulsive disorder. He has not engaged with psychological treatment. Initiation of which class of medication is most appropriate in this scenario? a. Acetylcholinesterase inhibitor b. Benzodiazepine c. Monoamine oxidase inhibitor d. Selective serotonin reuptake inhibitor e. Tricyclic antidepressant

Answer 25

d. Selective serotonin reuptake inhibitor

Question 26

A 55 year old woman in General Practice has a history of recurrent depression. She has previously had cognitive behavioural therapy and antidepressant medication. She is currently well but her work has been stressful and she is worried her depression may recur. Which is the most appropriate next management option? a. Group based CBT b. Mindfulness-based cognitive therapy c. Prescribe prophylactic SSRI d. Prescribe zopiclone e. Regular follow up with GP and screening for depression

Answer 26

e. Regular follow up with GP and screening for depression

Question 27

The mother of a 7 year old boy is concerned that he has always struggled to focus in class, wait for his turn and has lots of energy in comparison to his peers. He has few friends and has only been in one physical fight in his life. Which is the most likely diagnosis? a. Attention deficit hyperactivity disorder b. Conduct disorder c. Depression d. Psychosis e. Social anxiety

Answer 27

a. Attention deficit hyperactivity disorder

Question 28

A 34 year old woman with borderline personality disorder has taken a spontaneous paracetamol overdose after breaking up with her boyfriend. She had texted her friend afterwards because she worried about who would care for her children. She had locked herself in the bathroom before taking the overdose but had not stocked up on tablets. Which of the following would cause the most concern? a. Admitting the overdose was a spontaneous decision b. Expressing worry about who would look after her children if she was not around c. Locking the bathroom door before taking the overdose d. Not stocking up on tablets e. Texting her friend after taking the overdose

Answer 28

c. Locking the bathroom door before taking the overdose

Question 29

A 45 year old man in General Practice is requesting help with his alcohol consumption. He drinks one bottle of vodka a day. He begins shaking as if he has not had an alcoholic drink first thing in the morning. Previously, when he tried stopping drinking suddenly 2 years ago, he had a seizure. Which is the most appropriate management plan? a. Offer self-help guides b. Prescribe a reducing dose of chlordiazepoxide c. Prescribe acamprosate d. Prescribe thiamine e. Refer for inpatient detoxification

Answer 29

Inpatient detox

Question 30

A 55 year old man attends for a routine health review. He was seen on a few occasions last year after he was made redundant from his job as an IT technician. At the time he had low mood, anhedonia, insomnia and hopelessness, which all resolved after he found a new job. Which is the most likely diagnosis? a. Adjustment disorder b. Bipolar affective disorder c. Personality disorder d. Post-traumatic stress disorder e. Severe depressive disorder

Answer 30

a. Adjustment disorder?

Question 31

A 33 year old woman takes omeprazole, paroxetine, aripiprazole, and zopiclone for gastro-oesophageal reflux and bipolar affective disorder. She also takes the combined oral contraceptive pill. Her annual blood test show: sodium 135 mmol/L (135 - 145), potassium 4.2 mmol/L (3.5 - 5.3), urea 5.1 mmol/L (2.5 - 7.8), creatinine 63 umol/L (60 - 120), eGFR 90 (>60) and prolactin 622 UI/L (100 - 500). Which medication is most likely responsible? a. Aripiprazole b. Combined oral contraceptive pill c. Omeprazole d. Paroxetine e. Zopiclone

Answer 31

d. Paroxetine

Question 32

A 63 year old man is in General Practice for his annual medication review. His past medical history includes ischaemic heart disease, depression and rheumatoid arthritis. He is taking citalopram (10 mg once daily), bisoprolol (5 mg once daily), atorvastatin (40 mg once daily), methotrexate (15 mg once weekly) and aspirin (75 mg once daily). His blood results are as follows: sodium 130 mmol/L (135 - 145), potassium 4.2 mmol/L (3.5 - 5.3), urea 4.2 mmol/L (2.5 - 7.8), creatinine 93 umol/L (60 - 120). Which of his medications is the most likely cause of this derangement? a. Aspirin b. Atorvastatin c. Bisoprolol d. Citalopram e. Methotrexate

Answer 32

d. Citalopram

Question 33

A 30 year old man with a brain injury following a road traffic accident reports experiencing an odd smell of burnt plastic. He is surprised that this is not bothering his flatmates. He recently reported seeing an image of Jesus on the walls of his bedroom reciting the ten commandments. What is the most likely diagnosis?

Answer 33

TBI triggered psychosis

Question 34

A 17 year old girl in the Emergency Department has experienced a seizure. She appears confused and fatigued, and has an irregular heart rhythm. Her blood pressure is 170/90 mmHg. Her mother reports that she has anorexia nervosa and her father has been trying to force feed her. What diagnosis would most likely explain her clinical presentation?

Answer 34

refeeding syndrome

Question 35

A 56 year old man is brought to the Emergency Department by ambulance after he was found collapsed in a park. His pupils are constricted and his respiratory rate is 6 breaths per minute. What emergency medication should be administered in this scenario?

Answer 35

naloxone

Question 36

A 21 year old man with a history of drug use is detained under the Mental Health Act (1983) for treatment of an acute psychotic episode. He has been administered an initial dose of zuclopenthixol depot 2 days ago. His urine drug screen is positive for cannabis. He is confused, has muscle rigidity, fever and hyporeflexia. His temperature is 38.4C, pulse rate 113 bpm, BP 135/80 mmHg, respiratory rate 26 breaths per minute and oxygen saturation 96% breathing air. What is the most likely cause for the change in presentation?

Answer 36

neuroleptic malignant syndrome

Question 37

A 75 year old man with recurrent depressive disorder stopped taking his medication 1 month ago. He now has significant low mood and suicidal thoughts. He is admitted informally following an apparent attempt to hang himself. His wife died of cancer 2 years ago and he has no children. What level of observation should be provided by the ward nursing staff in this scenario?

Answer 37

1 to 1

Question 38

A 30 year old woman is admitted to the Mental Health Unit. She has reportedly been spending her savings on expensive items of clothing. Her named nurse reports that she hardly sleeps at night and seems unable to settle down. She is overfamiliar and labile in mood. A urine drug screen is negative for all substances and all blood test parameters are within normal limits. What is the likely diagnosis?

Answer 38

manic episode

Question 39

A 76 year old man who lives independently is admitted to the mental health unit with a severe depressive episode. He was managed in the community with multiple antidepressants at various times, but none have really benefited him. He completed a course of ECT treatment a few days ago. His family members visit him on the ward but he is unable to recognise them. What type of memory impairment is demonstrated?

Answer 39

amnesia

Question 40

A 35 year old woman who is 7 weeks postpartum, presents with low mood, anhedonia, poor energy levels, insomnia and fleeting suicidal thoughts. She has no previous history of mental illness. She is breastfeeding. Initiation of what medication class is most appropriate in this scenario?

Answer 40

SSRIs | fluoxetine or sertraline if breast-feeding

Question 41

A 24 year old man is brought to the Emergency Department by police. A neighbour had reported him shouting in his house, following which, he ran onto the street and began throwing rocks at passing cars. The police arrested him and brought him to hospital. Under what section of the Mental Health Act (1983) was he most likely detained?

Answer 41

136

Question 42

A 30 year old male with paranoid schizophrenia has been treated unsuccessfully with aripiprazole and later, olanzapine. He has ongoing delusions that his family and nursing staff are poisoning his food and medication. He hears two men arguing and commenting on his actions. What is next most appropriate pharmacological treatment option?

Answer 42

clozapine

Question 43

A 61 year old man with alcohol dependence is brought to the Emergency Department by ambulance following concerns by neighbours. He presents with confusion and disorientation. He is irritable, tremulous and sweating. He appears to be responding to external visual stimuli. His temperature is 37.9C, pulse rate 125 bpm, BP 140/95 mmHg, respiratory rate 20 breaths per minute and oxygen saturation 95% breathing air. His breathalyser reading is 80 microgram alcohol / 100 mL of breath (legal limit for drivers <35). What is the most likely diagnosis?

Answer 43

delirium tremens??? encephalopathy? korsakofff?

Question 44

A 13 year old boy attends the child psychiatry clinic with his parents, who describe a 7 month history of overeating. He frequently rummages through the cupboards at odd times of the day. He has said at times that he feels fat. His BMI is 18.5 kg/m2 (just under the 50th centile for his age). He has calluses on his knuckles. He performs well academically. What is the most likely diagnosis?

Answer 44

bulimia

Question 45

A 20 year old medical student has become increasingly isolated and has stopped attending lectures for the past 7 months. Concerns have been raised by his friends that he has been locking himself in his room and talking to himself. He believes that the government is spying on him and trying to steal his intelligence. He reports hearing female voices commenting on his actions. What is the most likely diagnosis?

Answer 45

paranoid schizophrenia

Question 46

A 20 year old woman in the outpatient clinic has sudden episodes of palpitations, shortness of breath, sweating, chest pain and dry mouth. These episodes started 6 months ago, occur randomly and last for about 15 minutes. Education and lifestyle modification advice have not been helpful. What is the most appropriate next step in regards to her management?

Answer 46

panic disorder so beta blockers or SSRI

Question 47

A 55 year old man in the outpatient clinic has been experiencing frequent thoughts of jumping onto the train tracks during his daily commute. This is very distressing for him as he does not consider himself to be suicidal. He has stopped taking the train and instead takes three buses to work, adding 1 hour to his journey time. He has received a warning for attending late. What is the most likely diagnosis?

Answer 47

OCD

Question 48

A 32 year old woman attends her GP surgery for her 6 week postnatal check. She has low mood, feels exhausted, is unable to sleep and is struggling to bond with her baby. She has lost her appetite and looks dishevelled. Her partner stated that she worries excessively about her baby. She has no previous psychiatric history. What is the most likely diagnosis?

Answer 48

post natal depression

Question 49

A 20 year old man has never been able to hold down a job for longer than a few months at a time. His relationships have also been affected by his symptoms. He has recently been diagnosed with ADHD by his psychiatrist. What medication would the psychiatrist most likely recommend in this scenario?

Answer 49

methylphenidate

Question 50

An 18 year old girl in General Practice has had no periods for the previous 4 months. She had the contraceptive implant inserted 2 years ago. She reports missing meals as she has been stressed for her university exams. She admits to making herself vomit occasionally when she is stressed. Her temperature is 36.8C, pulse rate 65 bpm, BP 109/70 mmHg, BMI 17.5 kg/m2. A pregnancy test is negative. What is the most likely diagnosis?

Answer 50

anorexia or bulimia?

Question 51

A 55 year old woman in General Practice is in a tearful state and reports feeling low. She advises that she gets cold easily and has been gaining weight. What investigation will likely be discriminatory in this scenario?

Answer 51

TFTs

Question 52

A 28 year old woman in General Practice is agitated. She had a healthy baby boy via normal spontaneous vaginal delivery 7 days ago. The birth and pregnancy were uncomplicated. She mentions her thoughts have been racing for the last few days and she has been hearing a voice telling her that her food is being poisoned by her husband. What is the most likely diagnosis?

Answer 52

puerperal psychosis

Question 53

Haloperidol induced parkinsonism, what would you use to treat?

Answer 53

anti cholinergic - procyclidine | decreased dose of haloperidol

Question 54

2. Man is sad 6w after his partner died, reduced appetite, difficulty sleeping, poor concentration, no suicidal thoughts, enjoys spending time with grandchildren. what is this?

Answer 54

normal grief reaction

Question 55

3. Anorexia nervosa patient admitted under MHA for feeding, confused, weakness, SOB. Which electrolyte abnormality?

Answer 55

hypophosphataemia

Question 56

4. Adolescent with 6m or so of depression symptoms, what's the next step in management

Answer 56

try psychological | if mod then fluoxetine

Question 57

5. Woman on antipsychotics is having fertility trouble, what blood level would you check?

Answer 57

prolactin levels | risperidone causes hyperprolactinaemia

Question 58

6. Man with OCD, CBT and SSRI aren’t working, what would you do next?

Answer 58

referral plus TCA or alternative SSRI

Question 59

7. Man whose partner left him 6m ago feels that his body is rotting, extensive hx of drinking since partner left, what is most likely dx?

Answer 59

alcohol abuse??

Question 60

8. Man w/ history of overdose wants to stop drinking and request detoxification, doesn't have support at home, what would you do?

Answer 60

admit

Question 61

9. Episodic palpitations, nausea and flushes with high levels of anxiety every time. What dx?

Answer 61

panic attacks, genralised anxiety disorder

Question 62

50yo with Down’s syndrome, remembers the way home from the shops but getting lost with other routes and personality change, increasingly aggressive and forgetful, most likely dx?

Answer 62

alzheimers

Question 63

11. Man with schizophrenia has tried 2 typical antipsychotics already with no effect, what drug would you try next?

Answer 63

clozapine

Question 64

12. Person on a load of drugs including salbutamol, clozapine with neutropenia, what drug is causing the neutropenia?

Answer 64

clozapine

Question 65

13. A man was punched in the face by his partner one week ago and is having trouble sleeping and it’s constantly on his mind, what’s the most likely dx?

Answer 65

acute stress reaction

Question 66

14. Anorexia- Restricting her energy intake, thinks she’s overweight, exercises and watches what she eats. What else is needed for dx of anorexia?

Answer 66

fear of gaining weight

Question 67

15. Editor of fashion magazine w/ history of depression starts having lots of energy, staying up really late to write new stuff. Manager is happy w/ her work and she feels 10/10, most likely dx?

Answer 67

bipolar affective disorder

Question 68

Man with a long face and large ears and learning disability can do most stuff but needs help from a carer with planning more complex things, most likely IQ?

Answer 68

65

Question 69

17. Woman who got married early, presents to the GP as she is very worried about her partner going away for 2 months as she cannot make everyday decisions without him, most likely dx?

Answer 69

dependent personality disorder

Question 70

18. Police brought someone in who was running around naked in town centre, what section did they use?

Answer 70

136

Question 71

On the day of discharge from the medical ward, admitted for an overdose, woman with diagnosed schizophrenia starts having hallucinations but wants to leave, what section would be suitable?

Answer 71

5(2)

Question 72

Bloke with mild depression, what would you do?

Answer 72

lifestyle advice and self IAPT referral

Question 73

21. Medical student 4 weeks before exams, severe anxiety (sob, palpitations), tried propanolol and hasn't worked and declined psychological intervention, what tx?

Answer 73

benzos

Question 74

22. Started on antipsychotic, develops muscle rigidity, pyrexia, HTN and tachypnoea, dx?

Answer 74

neuroleptic malignant syndrome

Question 75

23. 3 week history of third person auditory hallucinations, thinks his mum is trying to kill him (or something along those lines), what is most likely diagnosis?

Answer 75

Acute psychosis as less than 4 weeks

Question 76

24. Man with worsening short-term memory. Which part of the brain is affected?

Answer 76

hippocampus

Question 77

25. Man scratching his skin because he feels insects crawling on his skin, tachycardic. Dx?

Answer 77

delirium tremens

Question 78

26. Man with sharp chest pain, attended multiple hospitals with many different symptoms. Doctors can’t find anything wrong with him. He insists that he needs more investigations, doctors haven’t been able to find out what is wrong with him yet. Dx?

Answer 78

Somatisation

Question 79

27. Woman with asthma, palpitations and sweating every time leaving the house. Now orders groceries home. Tx?

Answer 79

agoraphobia

Question 80

28. Man with depression symptoms, which medication would you give? Has a history of myocardial infarction and type 2 diabetes.

Answer 80

sertraline

Question 81

29. Woman got into a fight while in a queue and does not regret, say it’s the other person’s fault. History of shop-lifting as a girl. Likely dx?

Answer 81

anti social personality disorder

Question 82

30. Man with piloerection and nausea, fever, requesting pain killers. Dx?

Answer 82

opiate withdrawal

Question 83

31. Patient on anti-depressant has long QT on ECG. Which medication?

Answer 83

citalopram

Question 84

32. Man with PTSD for 3 months, trauma-based CBT was unsuccessful. Next psychological Mx?

Answer 84

EMDR?

Question 85

33. Patient on anti-psychotic starts feeling restless. Next mx?

Answer 85

akathisia lower dose / switch anti psychotic propanolol or benzos

Question 86

34. Patient has weight gain, and is on a bunch of drugs. Which drug is likely to have caused this?

Answer 86

mirtazapine lol who knows

Question 87

1. Man thinks bloke on TV is talking about him, what is this phenomenon known as?

Answer 87

reference hallucinations

Question 88

2. Repetitive pouting of the lips on antipsychotic, what is it?

Answer 88

tardive dyskinesia

Question 89

3. Person with OCD, CBT was unsuccessful/declined, what class of drug to give?

Answer 89

SSRI

Question 90

4. Woman comes to A&E and is agitated, confused, high temperature, sweating, diarrhoea, muscles in her leg are twitching. Recently been started on medication for depression. What is the likely diagnosis?

Answer 90

seretonin syndrome

Question 91

5. A 70yo woman who can see people at the table that others can’t see and some memory impairment, most likely dx?

Answer 91

lower body dementia

Question 92

6. Woman w dementia keeps leaving care home at 3:00, what legal provisions/ which legal act would you consider to stop this from happening?

Answer 92

DOLS

Question 93

7. Being treated with lithium and having lithium levels, calcium, glucose and renal function checked, what else should be monitored?

Answer 93

TFTs

Question 94

8. Woman w history of suicide attempts following break-ups and intense relationships, dx?

Answer 94

emotional unstable personality disorder

Question 95

9. Woman with 6 month history of restricted eating, amenorrhoea, social anxiety, low mood. She has fine hair and a BMI of 17. Observations are normal. What is the best 1st line pharmacological treatment?

Answer 95

fluoxetine

Question 96

10. 40 year old doctor with central chest pain but no abnormalities on ECG. Which drug is likely to be causing this?

Answer 96

cocaine

Question 97

11. Man brought into A+E with constricted pupils and decreased resp rate. What immediate treatment do you want to give him?

Answer 97

naloxone

Question 98

12. Man thinks his wife is cheating on him and he has been verifying this by checking her underwear (damn he nasty). What is the most likely diagnosis?

Answer 98

Othello syndrome

Question 99

13. Woman has become blind after attending her mother’s funeral, does not seem to be concerned by the sudden onset of blindness. Physical exam and obs are normal. Most likely diagnosis?

Answer 99

conversion disorder

Question 100

14. 11 year old boy excluded from school due to destructive behaviour, including arson and has been cautioned by police for shoplifting. What is the likely diagnosis?

Answer 100

conduct disorder

Question 101

15. Woman with schizophrenia describes experiences when she feels like she is not real. What phenomenon is this?

Answer 101

depersonalisation ??

Question 102

16. Man comes into the hospital/care home, and a few weeks later is confused. History of heavy alcohol use. Most likely diagnosis?

Answer 102

wernickes? or

Question 103

17. Man comes to hospital 3 days ago for knee replacement surgery. Now complains of seeing ants crawling on him and has a tremor and confusion. What is the likely diagnosis?

Answer 103

delirium tremens

Question 104

18. Child with poor concentration and poor organisation skills, always interrupting others and fidgety. Most appropriate medication to start?

Answer 104

methylphenidate

Question 105

19. Old woman with indwelling catheter becomes agitated suddenly and has visual hallucinations. Dx?

Answer 105

-UTI ---> delirium

Question 106

20. Girl on antidepressant develops confusion, dizziness and weakness. What is the likely electrolyte abnormality?

Answer 106

hyponatraemia

Question 107

1. Sweating, irregularly irregular heartbeat. - give?

Answer 107

-

Question 108

2. Most important test for patient on clozapine

Answer 108

FBC

Question 109

3. Patient had knee surgery was not taking usual drug for anxiety disorder. Now she has coarse tremors, agitated, can’t sleep. What class of drugs is she not taking at the moment?

Answer 109

benzos

Question 110

4. Man who thinks body is rotting. What type of delusion is this?

Answer 110

cotard

Question 111

5. Loss of libido. DHx extensive . What is the cause of loss of libido?

Answer 111

cetirizine

Question 112

6. Boy with conduct disorder is most likely to get what personality disorder when older?

Answer 112

anti social

Question 113

7. 10 days after having baby - feels teary and not sure why she feeling like this about the baby

Answer 113

post partum blues

Question 114

8. Guy presents with itching but no cause. In the past has presented with tingling and other symptom

Answer 114

somatisation

Question 115

9. Deficiency of what vitamin is causing visual disturbances, ataxia and confusion

Answer 115

thiamine

Question 116

10. Test to do in woman who is scantily dressed, irritated,

Answer 116

thyroid levels

Question 117

1. Addict patient presenting with dilated pupils and goosebump flesh, what to prescribe for maintaining sobriety?

Answer 117

methadone

Question 118

2. Neuroleptic Malignant Syndrome - recently started on antipsychotic what test would you do?

Answer 118

creatine kinase levels

Question 119

3. Dad walked out asking about schizophrenia. Teenager daughter then asks at end of consultation whats the likelihood of schizophrenia herself

Answer 119

10%

Question 120

4. Fragile X syndrome guy with learning disability, gave a description of what tasks he can do independently and what tasks he needs help with - , most likely IQ?

Answer 120

65

Question 121

5. Treatment for patient with manic episode

Answer 121

olanzapine

Question 122

6. Girl with depressive episode in the past and was given antidepressants. Is now presenting to the GP wearing bright clothes, saying she is going to divorce her husband and move abroad- what is the diagnosis?

Answer 122

bipolar affective disorder

Question 123

7. Medical management of OCD?

Answer 123

SSRI

Question 124

8. Man on ward behaving aggressively, what do you do?

Answer 124

verbal de escalation then oral then IM lorazepam

Question 125

9. Girl with eating disorder, vomiting. Will she have a: metabolic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis?

Answer 125

metabolic alkalosis

Question 126

10. Vascular risk factors for vascular dementia - how do you treat?

Answer 126

aspirin

Question 127

11. You are the GP and 14 year old girl comes in and is Gillick competent, she is given COCP. a few days later her mum rings and says ‘she doesn’t like the new boyfriend’ and asks why her daughter has the pill and what happened in the consultation. What should you do? I. Tell the mum everything II. Tell her her daughter requested the OCP to not get pregnant and you thought it was a sensible decision III. Offer joint consultation with the mother and daughter IV. Say you can't discuss it with her, encourage them to talk about it at home

Answer 127

IV. Say you can't discuss it with her, encourage them to talk about it at home

Question 128

There was a chef who kept washing his hand, had loads of obsessions but he was hearing a voice??(i think) what did he have?

Answer 128

psychotic episode

Question 129

Paramedic sees a patient die 1 month ago. He is sad and can't sleep. What Dx?

Answer 129

PTSD

Question 130

Girl witnesses car crash and goes few hours later blind. Dx?

Answer 130

dissociative disorder

Question 131

Mum with 20 units a day alcohol habit hides in room with 2 day newborn baby and think house is infested (maybe thinks insects crawling on wall?). What Dx?

Answer 131

alcohol withdrawal

Question 132

Recurrent intrusive thoughts about child pornography but is distressed

Answer 132

OCD

Question 133

Bodybuilder on steroids - change in behaviour.

Answer 133

steroid psychosis

Question 134

Kid interrupts teachers, cannot concentrate, crosses road without looking

Answer 134

ADHD

Question 135

7 year old with ADHD, 1st line treatment

Answer 135

parental teaching | methylphenidate

Question 136

Guy prescribed citalopram, name one possible side effect he should be told about?

Answer 136

prolonged QT

Question 137

Guy who sticks his tongue out without realising and grimacing

Answer 137

tardive dyskinesia????

Question 138

Treatment for torticollis

Answer 138

anti cholinergic - procyclidine

Question 139

Girl drops out of university, has no friends, finds it difficult to express her feelings

Answer 139

prodromal schizo

Question 140

Guy scared of public speaking. Doesnt want to leave house.

Answer 140

social phobia

Question 141

Paitent with a bunch of symptoms (hates queueing in shop- starts blushing?(something like this), can’t get on public transport and a few others) Which most suggest social phobia?

Answer 141

blushing

Question 142

Disinhibition-guy being inappropriate at work... where is lesion?

Answer 142

frontal lobe

Question 143

Woman with dementia, which part of brain is likely to be affected early?

Answer 143

hippocampus

Question 144

Guy with AMTS of 6/10… and no longer enjoys gardening anymore. ?

Answer 144

Pseudo dementia

Question 145

Something about a women, who since her husband has died as started forgetting things, left oven on or something?

Answer 145

psuedodementia

Question 146

1 month after having a baby, low mood, anergia -

Answer 146

post partum depression

Question 147

Woman believes celebrity is her lover and writers letters to him. Then stalks him

Answer 147

de clarembault syndrome

Question 148

Woman with borderline personality disorder, treatment?

Answer 148

dialectical behavioural therapy

Question 149

Man has hallucinations and movement seems slower than usual -

Answer 149

Lewy body?? if he's old

Question 150

Woman has CS. 1 day after giving birth thinks she is at home when she is actually still in hospital. What is the diagnosis?

Answer 150

acute confusional state

Question 151

Man who is aggressive to staff

Answer 151

verbal de escalation then IM lorazepam

Question 152

Man with hyper-reflexia and tremor, what drug

Answer 152

lithium

Question 153

Section for a 38 year old woman who lacks capacity and wants to kill herself in A&E?

Answer 153

section 2

Question 154

Man who stays in room and avoids social interaction

Answer 154

social phobia

Question 155

Which drug is most likely to cause neuroleptic malignant syndrome?

Answer 155

Haloperidol

Question 156

Alcoholic has cellulitis, given chlordiazepoxide and Abx, what else do you give

Answer 156

-pabrinex

Question 157

Old man who was ex-accountant has like MMSE 28/30, getting somewhat forgetful and needs wife to do his finances as he gets confused, but manages all other daily activities. what’s the diagnosis?

Answer 157

-

Question 158

Woman with learning difficulties in a care home with change in behaviour (reduced appetite (not reduced appetite - was change in feeding time), irritable etc didn’t think she actually met any criteria for any mental health issues.) because the carer that was looking after them has gone suddenly, what’s the diagnosis?

Answer 158

autism

Question 159

Some girl with anorexia was admitted and she started eating and stuff. Then she gets muscle spasms, and abdominal pain and stuff. What would be deranged/ what’s the most important thing to check for???

Answer 159

referring syndrome - hypomagnesium or hypophosphataemia?

Question 160

Drug to give for depression in a guy who had an MI.

Answer 160

sertraline

Question 161

Old age boxer rips out cannula, attacks staff what do you do?

Answer 161

verbal de escalation then IM lorazepam

Question 162

What does clozapine cause

Answer 162

agranulocytosis

Question 163

Guy whose wife died a year ago, has 6 months of low mood, low energy, doesn’t like doing what he used to, getting forgetfl, lacking concentration

Answer 163

Abnormal grief reaction or depression

Question 164

Guy on haloperidol gets muscle problems

Answer 164

could be start of NMS | or EPSE

Question 165

Woman experienced trauma 6 months ago/has PTSD best management?-

Answer 165

trauma based CBT

Question 166

Guy works as an IT engineer, doesn’t like sex, or people

Answer 166

schizoid personality disorder

Question 167

Guy worries about running kids over so has to check the road or something everytime

Answer 167

OCD

Question 168

Girl, drops out of uni, goes back home lives with mother and thinks mother is poisoning her

Answer 168

schizophrenia

Question 169

Girl comes to A&E overdose after argument with boyfriend, previous history of overdosing

Answer 169

emotionally unstable personality disorder

Question 170

Woman basically blushes in public

Answer 170

social phobia

Question 171

Guy has a fear of public speaking, worried about embarrassing himself, hasn’t seen his personal tutor, hasn’t left the house in a while?

Answer 171

social phobia

Question 172

Woman has been spending loads of money, lots of energy, little sleep, going on for 6 weeks but not affecting her work (although feels more imaginative)

Answer 172

hypomania

Question 173

Old woman in care home, no PMH, no psych history, nurses complain she wakes up in night and sleeps in day- what do you do first

Answer 173

sleep hygiene

Question 174

Some 25 year old students with asthma/diabetes, stressed about exams for 6 weeks and his exams are coming up in like 2 weeks. What do you do?

Answer 174

benzos

Question 175

Girl is anorexic (like 14.3 BMI)- discharge to GP, discharge to CAMHS, use the MHA and feed her (rapid psych says if BMI dangerously low then use MHA to admit and put in NG tube to feed - don’t think it met the criteria, this it’s around <13/14 BMI), routine referral to eating disorder clinic, emergency CAMHS, urgent referral to A&E

Answer 175

A and E

Question 176

Some schizo making a scene in public and police want to detain him, which MHA?

Answer 176

136

Question 177

Woman on venlafaxine, starts developing symptoms of mania (BAD), what do you do?

Answer 177

stop the venlafaxine and start anti psychotic acutely plus mood stabiliser

Question 178

50 year old guy wanders in screaming he sees ants and tiny men running around

Answer 178

Lewy body dementia

Question 179

Alcoholic wants to quit and wants something for reducing cravings

Answer 179

acamprostate

Question 180

Guy on antipsychotic comes in with tremor- most likely drug

Answer 180

haloperidol

Question 181

Dude with LBD, given a drug that makes him worse, what drug?

Answer 181

anti psychotic probably

Question 182

Kid is very disruptive in class/at home/has trouble organizing himself what’s the diagnosis

Answer 182

ADHD

Question 183

Child has classic symptoms of ADHD, how do you manage?

Answer 183

family training and methylphenidate

Question 184

Guy writes letters to the PM, think he’s being spied on by the government for the past 10 years, shows no other symptoms

Answer 184

delusional disorder

Question 185

Guy comes requesting for codeine, concerned his painkiller use is spiralling, see some degeneration in his spine on imaging-

Answer 185

-

Question 186

What would an alcoholic need to have to be classified as being dependent

Answer 186

dependence

Question 187

Guy has rercurent mental images of child pornography, finds them deeply distressing, seeking help

Answer 187

OCD

Question 188

Man with history of paranoid schizophrenia, his Ix and tests are strongly suggestive of an MI, needs treatment. He has capacity and refuses treatment - what should you do

Answer 188

let him leave and sign the form saying he went abasing medical advice

Question 189

Some with dilated pupils, urinary retention, obs normal-ish - cause of overdose?

Answer 189

lithium

Question 190

Lithium - what do you monitor?

Answer 190

lithium levels and TFTs

Question 191

Husband brings in wife who has bipolar, who’s taken 20 “white” tablets - has a tremor and other sx. What tablet has she overdosed on?

Answer 191

lithium

Question 192

Patient on ward becomes aggressive, verbal de-escalation hasn’t worked. Tx?

Answer 192

IM lorazepam

Question 193

50y lady fell over gardening, comes in with paralysis of leg, no medical cause found?

Answer 193

conversion

Question 194

Man who drinks a bottle of wine a day for the last 10 years, has tried to quit before but failed. Wanting to cut down?

Answer 194

medications, acomprostate or the other one lol

Question 195

A girl has come in with recurrent abdominal pain associated with going to school. She is diagnosed with functional abdominal pain. What would your advice be with regards to her management? ● She should return to school but come home when the pain starts ● She should be homeschooled ● She should change school ● She should arrange for schoolwork to be delivered to her house until she gets better ● She should return to school and remain there, even if the pain starts.

Answer 195

She should return to school and remain there, even if the pain starts.

Question 196

first line ADHD management

Answer 196

family training then methylphenidate

Question 197

postpartum depression treatment

Answer 197

CBT and counselling | fluoxetine

Question 198

16 y o having sex with a 12 year old - what is your next action?

Answer 198

call the police

Question 199

Woman who had FGM when she was 6 and is not pregnant and said she definitely won't do on her daughter - what do you do?

Answer 199

Refer to FGM clinic for reversal and psycho sexual counselling

Question 200

Woman comes in with a pneumothorax and said her husband kicked her and has previously hurt their baby too. Baby is currently at home with him - what do you do?

Answer 200

involve the police

Question 201

Boy always playing video games from teenage years, not interested in other people threatening to kill himself?

Answer 201

schizoid personality disorder

Question 202

Suicide risk. What is the highest predictor of doing it again?

Answer 202

didn't tell anyone, no protective factors

Question 203

80 year old man with new onset dementia, needs MRI but refuses. You need someone to make decision for him.

Answer 203

next of kin or IMCA???

Question 204

Guy who has visual hallucination and likely to fall over. but he is not giving consent to help regarding his falls and delirium. He wants to leave hosp. Difficult to understand what he is saying Q: what is a big reason that makes you think he does not have capacity?

Answer 204

cannot repeat the information back as difficult to understand

Question 205

Woman on SSRI, wanted to get pregnant, was wondering what risk it may have on her baby

Answer 205

cardiac defects in first trimester and persistent pulmonary hypertension in third trimester

Question 206

Woman wants to know what risk her baby has of getting schizophrenia, since the baby’s father has it.

Answer 206

10%

Question 207

Woman 5 weeks postpartum feels very sad, unable to cope, teary. Dx?

Answer 207

post partum depression

Question 208

What blood test should be frequently done if someone is on Lithium?

Answer 208

lithium levels and thyroid

Question 209

Guy on medication for schizophrenia get muscle rigidity, altered consciousness, high blood pressure, tachycardia. Mgmt?

Answer 209

stop the anti psychotic and supportive | dantrolene bromocriptine

Question 210

60 year old woman, short term memory loss, struggling to complete her normal daily tasks, ataxia and dysphagia. What would you see on MRI

Answer 210

Temporal lobe atrophy

Question 211

40 year old man with moderate learning disability. He has a Hb of ~6 (below the normal range). Refuses blood transfusion but happy to take oral iron therapy. What law do you use to assess his decision (or something along those lines).

Answer 211

mental capacity act

Question 212

Man who had come into GP for peeling of skin on his hands. Excessive hand washing 6 times daily which has got worse since his elderly father died 3 months ago following a wound infection(?)

Answer 212

OCD

Question 213

What is high in anorexia nervosa?

Answer 213

cholesterol

Question 214

Man with treatment resistant schizophrenia on clozapine, recently stopped smoking. High level of clozapine now. Most likely consequence?

Answer 214

sudden smoking cessation less to higher serum clozapine levels

Question 215

Alcoholic comes to GP requesting home detoxification. Previous history of delirium tremens. What would you do?

Answer 215

prescribe chlordiazepoxide | consider inpatient withdrawal?