Psych past paper (16-21) Flashcards by J Akoro

A 32 year old woman with bipolar affective disorder is in the 11th week of her first pregnancy. She has not been taking medication for the last 3 months and wants to remain medication free throughout the pregnancy and postnatal period.

Rank the following disorders in order of likelihood of occurrence in this woman with (1) being the most likely and (5) being the least likely.

a. Post-traumatic stress disorder
b. Puerperal psychosis
c. Postnatal depression
d. Alcohol use disorder
e. Generalised anxiety disorder

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A 21 year old woman in the Emergency Department states that she is going to kill herself because the voices in her head are telling her to do so. Her feelings reportedly intensified following an argument with her mother earlier in the day. She demands to be admitted to the mental health unit, saying ‘it will all be your fault when I commit suicide”. She has a history of cutting and is well known to mental health services from previous crisis presentations.

Rank the following differential diagnoses in order of likelihood, with (1) being the most likely and (5) being the least likely.

a. Dissocial personality disorder
b. Paranoid schizophrenia
c. Depressive episode of moderate severity
d. Severe depressive episode with psychotic features
e. Emotionally unstable personality disorder

e. Emotionally unstable personality disorder

……

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A 37 year old woman in the Emergency Department has low mood, insomnia, an inability to concentrate and hopelessness for the past 6 weeks. She recently lost her job as a corporate lawyer. She had an episode of depression at the age of 26 years, which was treated with fluoxetine for 6 months. She reports being a social drinker (average consumption is 2 glasses of wine per week).

Rank the following risk factors for depression in order of significance for this woman, with (1) being the most significant and (5) being the least significant.

a. Alcohol intake
b. Gender
c. Age
d. Previous depressive episode
e. Recent unemployment

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The son of an 81 year old man in General Practice is concerned about his father. His father lives alone and has become more forgetful over the past 3 months. He has left his house without shutting the door several times and has been getting lost on the way to the shops. He has well-controlled hypertension and diet-controlled Type 2 Diabetes Mellitus.

Rank the following management steps according to the sequence in which they should be implemented with (1) being carried out first and (5) being carried out last.

a. Arrange joint consultation with father and son
b. Refer to local Memory Clinic
c. Perform an assessment of cognition with a cognitive assessment tool
d. Arrange confusion screen blood tests
e. Assess for acute reversible causes of confusion

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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

d. Severe depressive episode without psychotic features

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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

c. He has limited social contacts

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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

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

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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)

a. Cholesterol

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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

e. Stop venlafaxine

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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

c. Olanzapine

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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

e. Vascular dementia

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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

d. Preoccupation with food

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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

b. Facilitate a Mental Health Act assessment

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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

d. Quetiapine and lithium

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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

c. Hypochondrial disorder

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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

b. De Clerambault syndrome (erotomanic delusions)

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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)

d. Increase the dose of sertraline

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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

a. Acute psychotic disorder

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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

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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

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

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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

c. MoCA (Montreal Cognitive Assessment)

?????

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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

b. Delirium

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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

a. Alzheimer’s disease

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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

c. Methadone

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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

c. Call the duty psychiatrist for an urgent assessment

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

b. Adjustment disorder

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

a. Circumstantiality

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

b. Dependence

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

d. Selective serotonin reuptake inhibitor

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

e. Regular follow up with GP and screening for depression

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

a. Attention deficit hyperactivity disorder

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

c. Locking the bathroom door before taking the overdose

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

Refer for inpatient detoxification

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

a. Adjustment disorder?

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

d. Paroxetine

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

d. Citalopram

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?

TBI triggered psychosis

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?

refeeding syndrome

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?

naloxone

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?

neuroleptic malignant syndrome

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?

1 to 1

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?

manic episode

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?

amnesia

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?

SSRIs | fluoxetine or sertraline if breast-feeding

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?

136

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?

clozapine

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?

delirium tremens??? encephalopathy? korsakofff?

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?

bulimia

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?

paranoid schizophrenia

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?

panic disorder so beta blockers or SSRI

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?

OCD

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?

post natal depression

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?

methylphenidate

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?

anorexia or bulimia?

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?

TFTs

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?

puerperal psychosis

Haloperidol induced parkinsonism, what would you use to treat?

anti cholinergic - procyclidine | decreased dose of haloperidol

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?

normal grief reaction

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

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

try psychological | if mod then fluoxetine

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

prolactin levels | risperidone causes hyperprolactinaemia

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

referral plus TCA or alternative SSRI

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?

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

admit

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

panic attacks, genralised anxiety disorder

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?

alzheimers

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

clozapine

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

clozapine

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?

acute stress reaction

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

fear of gaining weight

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?

bipolar affective disorder

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?

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?

dependent personality disorder

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

136

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?

2(5)

Bloke with mild depression, what would you do?

lifestyle advice and self IAPT referral

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

benzos

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

neuroleptic malignant syndrome

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?

acute psychotic disorder as less than one month

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

temporal

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

delirium tremens

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?

somatisation disorder

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

agoraphobia

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

sertraline

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?

anti social personality disorder

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

opiate withdrawal

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

citalopram

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

EMDR?

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

akathisia lower dose / switch anti psychotic propanolol or benzos

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

mirtazapine lol who knows

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

ideas of reference

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

tardive dyskinesia

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

SSRI

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?

seretonin syndrome

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

lower body dementia

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?

DOLS

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

TFTs

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

emotional unstable personality disorder

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?

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

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

naloxone

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?

Othello syndrome

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?

conversion disorder

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?

conduct disorder

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

depersonalisation ??

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

wernickes? or

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?

delirium tremens

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

methylphenidate

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

-UTI ---> delirium

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

hyponatraemia

1. Sweating, irregularly irregular heartbeat. - give?

2. Most important test for patient on clozapine

FBC

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?

benzos

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

cotard

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

anti depressant

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

anti social

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

post partum blues

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

Somatisation disorder

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

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

thyroid levels

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

methadone

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

creatine kinase levels

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

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?

Q 65 most likely (other options: 20, 40, 80, 110)

5. Treatment for patient with manic episode

anti psychotics

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?

bipolar affective disorder

7. Medical management of OCD?

SSRI

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

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

metabolic alkalosis

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

give aspirin to limit further damage

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

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

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?

OCD

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

a. Acute stress reaction

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

conversion disorder

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?

puerperal psychosis

Recurrent intrusive thoughts about child pornography but is distressed

OCD

Bodybuilder on steroids - change in behaviour.

steroid psychosis

Kid interrupts teachers, cannot concentrate, crosses road without looking

ADHD

7 year old with ADHD, 1st line treatment

family teaching | methylphenidate

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

prolonged QT

Guy who sticks his tongue out without realising and grimacing

tardive dyskinesia????

Treatment for torticollis

anti cholinergic - procyclidine

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

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

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?

blushing

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

frontal lobe

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

hippocampus

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

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

pseudodementia

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

post partum depression

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

de clarembault syndrome

Woman with borderline personality disorder, treatment?

dialectical behavioural therapy

Man has hallucinations and movement seems slower than usual -

Lewy body?? if he's old

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

delirium

Man who is aggressive to staff

verbal de escalation then IM lorazepam

Man with hyper-reflexia and tremor, what drug

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

Man who stays in room and avoids social interaction

social phobia

Which drug is most likely to cause neuroleptic malignant syndrome?

Haloperidol

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

-pabrinex

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?

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?

autism

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???

referring syndrome - hypomagnesium or hypophosphataemia?

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

sertraline

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

verbal de escalation then IM lorazepam

What does clozapine cause

agranulocytosis

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

normal grief reaction

Guy on haloperidol gets muscle problems

could be start of NMS | or EPSE

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

trauma based CBT

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

schizoid personality disorder

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

OCD

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

schizophrenia

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

emotionally unstable personality disorder

Woman basically blushes in public

social phobia

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?

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)

hypomania

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

sleep hygiene

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?

cbt, benzos

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

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

136

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

stop the venlafaxine and start anti psychotic acutely plus mood stabiliser

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

Alcoholic wants to quit and wants something for reducing cravings

acamprostate

Guy on antipsychotic comes in with tremor- most likely drug

haloperidol

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

anti psychotic probably

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

ADHD

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

family training and methylphenidate

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

delusional disorder

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

Buprenorphine + addiction clinic referral

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

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

OCD

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

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

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

Lithium - what do you monitor?

lithium levels and TFTs

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?

mood stabiliser

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

IM lorazepam

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

Conversion disorder

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?

medications, acomprostate or the other one lol

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.

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

first line ADHD management

family training then methylphenidate

postpartum depression treatment

CBT and counselling | sertraline and paroxetine

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

call the police

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?

call the police

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?

involve the police

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

schizoid personality disorder

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

didn't tell anyone, no protective factors

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

next of kin or IMCA???

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?

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

nice says no proper evidence of any congenital malformations, but some suggestions of cardiac defects

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

10%

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

post partum depression

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

lithium levels and thyroid

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

stop the anti psychotic and supportive | dantrolene bromocriptine

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

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).

mental capacity act

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(?)

OCD

What is high in anorexia nervosa?

cholesterol

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

sudden smoking cessation less to higher serum clozapine levels

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

prescribe chlordiazepoxide | consider inpatient withdrawal?

Psych past paper (16-21) Flashcards

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