Psychiatry EMQs from PRN online Flashcards Preview

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Flashcards in Psychiatry EMQs from PRN online Deck (125)
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1

A. Summarising
B. Active listening techniques
C. Question funnelling
D. Linking
E. Reflection
F. Platitudes
G. Paternalism
H. Empathy
I. Motivational interviewing
J. Bargaining

Student: What happened today to bring you into hospital?

Bob: Well, I got back from visiting my family in Australia, only a few days ago. I was a bit jet-lagged, but pretty good otherwise. Then yesterday, my leg swelled up - really painful! It hurts to walk on it. I kind of thought it would go down, but it didn't, so I came in here.

Student: What else have you noticed?

Bob: It's gone really red - and hot. It's only the right leg, and it makes the left one look tiny by comparison.

Student: I see... Have you had any problems with your breathing?

Bob: No.

C. Question funnelling

Question funnelling is a useful technique, whereby the interviewer starts with an open question(s) and moves to closed or clarifying questions. It allows the patient to freely express what has happened to them whilst enabling you to direct the conversation.

2

A. Summarising
B. Active listening techniques
C. Question funnelling
D. Linking
E. Reflection
F. Platitudes
G. Paternalism
H. Empathy
I. Motivational interviewing
J. Bargaining

Student: You've given me a lot of information. Can I just see if I've got this right?

Ahmed: OK

Student: You lost your job about 3 months ago, which led to money problems. Since then you've felt increasingly that your life was out of control, and that planning for the future is pointless. You've been having a lot of trouble sleeping, which has left you feeling tired.

Ahmed: That's right. I'm so tired I can't get out the house anymore. I feel bad for my wife - I must be making her so miserable.

A. Summarising

3

A. Summarising
B. Active listening techniques
C. Question funnelling
D. Linking
E. Reflection
F. Platitudes
G. Paternalism
H. Empathy
I. Motivational interviewing
J. Bargaining

Anneke: Since the attack, I haven't been able to let my partner near me. It seems stupid, but I'm just so edgy all the time.

Student: I'm sure he understands.

Anneke: Actually, I don't think he gets what I'm going through... I can't see how things will improve until I can sort my head out.

Student: Well, things will get better - they always do.

F. Platitudes

usually unhelpful, since they can come across as dismissive or patronising - no matter how well intended they were.

4

A. Summarising
B. Active listening techniques
C. Question funnelling
D. Linking
E. Reflection
F. Platitudes
G. Paternalism
H. Empathy
I. Motivational interviewing
J. Bargaining

Dimitrios: I don't need to be here. I don't even want to be here. I'm only here because my parents are overreacting. I just don't want to be spied on by the others anymore.

Student: The others?

Dimitrios: Yeah. Them that follow me. They hear everything I say - and even my thoughts when it's quiet. I'm tired of it...

E. Reflection

5

A. Summarising
B. Active listening techniques
C. Question funnelling
D. Linking
E. Reflection
F. Platitudes
G. Paternalism
H. Empathy
I. Motivational interviewing
J. Bargaining

Jean: I need something to help me sleep, Doc. I can't seem to drop off at night, and then I wake up really early.

Student: I'd imagine that would leave you feeling really tired. Have you noticed that you don't have as much energy recently?

Jean: Yeah, it's really hard to get going lately. Everything seems like a battle...

Student: I'm so sorry... How long have you been feeling like this?

D. Linking

6

A. Akathisia
B. Parkinsonism
C. Tardive dyskinesia
D Mannerisms
E. Stereotypies
F. Tics
G. Compulsions
H. Catatonia
I. Intention tremor
J. Dystonia

You are a junior doctor working in general practice. Mrs Patel is a 78 year old woman who comes to see you complaining that her hands have been shaking for a few weeks, her left worse than the right. She thought it would pass but it hasn't. She keeps knocking drinks over and is finding it difficult to write.

I. Intention tremor

7

A. Akathisia
B. Parkinsonism
C. Tardive dyskinesia
D Mannerisms
E. Stereotypies
F. Tics
G. Compulsions
H. Catatonia
I. Intention tremor
J. Dystonia

Gustav Erikson is a 46 year old man who has been treated for paranoid schizophrenia for the last 12 years. His family have noticed that recently he has been grimacing and pulling faces. It seems to be getting worse and they are concerned that he is reacting to hallucinations again.

Tardive dyskinesia

usually a delayed side effect of antipsychotic use

8

A. Akathisia
B. Parkinsonism
C. Tardive dyskinesia
D Mannerisms
E. Stereotypies
F. Tics
G. Compulsions
H. Catatonia
I. Intention tremor
J. Dystonia

Esther Smithson is a 24 year old woman who was admitted with an acute psychotic episode and has been taking risperidone for 3 weeks. You are a senior house officer working on her ward, and have been asked to see her by nursing staff, since she "keeps pacing by the door". Staff are concerned that she is trying to abscond. During the consultation you notice that she seems on edge and unable to settle. On several occasions she rises from her seat to pace up and down.

Akathisia

is an unpleasant subjective sense of restlessness, and is an extrapyramidal side effect of antipsychotic use.

9

A. Akathisia
B. Parkinsonism
C. Tardive dyskinesia
D Mannerisms
E. Stereotypies
F. Tics
G. Compulsions
H. Catatonia
I. Intention tremor
J. Dystonia

Charles Crawford is a 26 year old man, who has been brought to see you by his wife, Cindy. He was playing football in the garden with their son, Michael, and had to stop because his eyes "got stuck looking up". He is very frightened, and says his eyes hurt. You note that he is taking quetiapine following a manic episode.

Dystonia

A common extrapyramidal side effect of antipsychotic use. This particular dystonia is an oculogyric crisis.

10

A. Akathisia
B. Parkinsonism
C. Tardive dyskinesia
D Mannerisms
E. Stereotypies
F. Tics
G. Compulsions
H. Catatonia
I. Intention tremor
J. Dystonia

Sebastian Epstein is a 54 year old who has been treated with haloperidol for 10 years. His wife has noticed that he has become very shaky. When he is watching television is unable to keep his hands still. It seems to be getting worse.

Parkinsonism

A common extrapyramidal side effect of antipsychotic use.

11

A. Dysarthria
B. Dysphasia
C. Clang associations
D. Punning
E. Neologisms
F. Pressure of speech
G. Poverty of speech
H. Flight of ideas
I. Perseveration
J. Loosening of associations

You are a house officer attached to a general medical firm. You are asked to assess the mental state of Johan Wicklestein. Johan is a 62 year old man with Parkinson's disease. The nursing staff, who know him from previous admissions, have noticed that he seems to have low mood. During your assessment you notice that although he understands you and answers all questions appropriately, he seems to have problems articulating his words.

Dysarthria

Describes problems with articulation of speech - the brain knows what it wants to say, but problems with the speech apparatus makes this difficult.

12

A. Dysarthria
B. Dysphasia
C. Clang associations
D. Punning
E. Neologisms
F. Pressure of speech
G. Poverty of speech
H. Flight of ideas
I. Perseveration
J. Loosening of associations

You are a final year medical student on a psychiatry firm. You are asked to assess the mental state of Marjorie Wilson. Marjorie's speech is coherent and does not seem to jump from topic to topic, but she speaks so quickly that you find her uninterruptible, and struggle to keep up with her.

Pressure of speech

Describes speech that is very fast and full of thoughts. It reflects underlying pressure of thought, and can feel a little like machine gun fire!

13

A. Dysarthria
B. Dysphasia
C. Clang associations
D. Punning
E. Neologisms
F. Pressure of speech
G. Poverty of speech
H. Flight of ideas
I. Perseveration
J. Loosening of associations

You are a final year medical student on a psychiatry firm. You interview Marcus Steinway, a 32 year old man. He was brought into hospital by his wife, after she became concerned that his mood seemed 'very black'. Marcus is quiet and withdrawn. He takes a long time to answer your questions and gives mostly monosyllabic answers, struggling to fill out any details.

Poverty of speech

The speech is slow with very few thoughts. It reflects underlying poverty of thought.

14

A. Dysarthria
B. Dysphasia
C. Clang associations
D. Punning
E. Neologisms
F. Pressure of speech
G. Poverty of speech
H. Flight of ideas
I. Perseveration
J. Loosening of associations

You asked your student, Helen, to clerk Wallace Guilfoye, a 32 year old man with schizophrenia. After an hour, Helen returns, exasperated. She tells you, "I couldn't follow anything he said - I kept thinking I'd got a hold on what he meant, and then he'd confuse me! He couldn't get through more than a sentence or two without losing me."

Loosening of associations

Describes the loss of normal links between thoughts.

15

A. Dysarthria
B. Dysphasia
C. Clang associations
D. Punning
E. Neologisms
F. Pressure of speech
G. Poverty of speech
H. Flight of ideas
I. Perseveration
J. Loosening of associations

You are a house officer working in accident and emergency. You see Mr McKeen, a 25 year old man who is experiencing psychotic symptoms. He talks in detail about the "interphalancrial business" and the "hemislayer" that have been persecuting him.

Neologisms

"new words" invented by the patient.

16

A. Grandiose
B. Thought withdrawal
C. Nihilistic
D. Erotomanic
E. Thought broadcasting
F. Jealousy
G. Reference
H. Guilt
I. Hypochondrial
J. Persecutory

Steve is a 22 year old physics student. His flat mate, Hussein, brings him to your GP surgery. Hussein tells you how Steve has become increasingly withdrawn, refusing to leave his room for days at a time. Steve insists on wearing a thick hat in all weathers, which he says is "for protection". On close questioning, Steve explains that his lecturers have been "spraying" his thoughts across the lecture hall with mobile phone technology. He hates knowing that all the other students know what he is thinking.

E. Thought broadcasting

17

A. Grandiose
B. Thought withdrawal
C. Nihilistic
D. Erotomanic
E. Thought broadcasting
F. Jealousy
G. Reference
H. Guilt
I. Hypochondrial
J. Persecutory

Mary Hamilton is a 36 year old woman who has been referred by her GP to your psychiatry outpatient clinic. She has received a verbal warning from the police after allegedly stalking the chief executive at the firm where she works as a cleaner. She has been sending him love letters and presents. Mary is convinced that he loves her, and says that the police warning is "just for show", to hide their love from her colleagues. Her manager is openly gay, and now off work due to the stress associated with Mary's behaviour.

D. Erotomanic

Erotomanic delusions are those in which there is a false belief that someone (often of higher status) is in love with the patient. They are more common in women and sometimes called "amorous delusions".

18

A. Grandiose
B. Thought withdrawal
C. Nihilistic
D. Erotomanic
E. Thought broadcasting
F. Jealousy
G. Reference
H. Guilt
I. Hypochondrial
J. Persecutory

Nigel Pieterson is a 54 year old man, referred to you by the police after he walked into his local police station and confessed to the murder of his mother. There were concerns that he was mentally ill, and he was brought to hospital. You contact his younger sister, who explains that their mother died 52 years before, in childbirth.

H. Guilt

This is a delusion of guilt. Mr Pieterson clearly had nothing to do with his mother's death while she gave birth to his younger sibling

19

A. Grandiose
B. Thought withdrawal
C. Nihilistic
D. Erotomanic
E. Thought broadcasting
F. Jealousy
G. Reference
H. Guilt
I. Hypochondrial
J. Persecutory

Stephano Romero is a 25 year old man who has been brought to Accident and Emergency by his mother. She noted that he has been acting strangely for some weeks, laughing to himself and spending a lot of time at the local church. This evening, he pointed out eight people crossing the road ahead, and nodded sagely, telling her that this meant that The End Was Nigh.

G. Reference

Delusions of reference are those in which special meaning, signs or signals are found in everyday events.

20

A. Grandiose
B. Thought withdrawal
C. Nihilistic
D. Erotomanic
E. Thought broadcasting
F. Jealousy
G. Reference
H. Guilt
I. Hypochondrial
J. Persecutory

Gloria Bunford is a 57 year old woman, who attends your GP surgery to make you aware that she died last Thursday.

C. Nihilistic

The belief that you are dead is classed as a nihilistic delusion. Nihilism is to do with the absence of things - in this case, the absence of life.

21

A. Manic episode
B. Cyclothymia
C. Schizoaffective disorder
D. Delirium
E. Bipolar affective disorder
F. Schizophrenia
G. Depressive episode
H. Pseudodementia

Persecutory delusions and auditory hallucinations without a strong mood component.

F. Schizophrenia

22

A. Manic episode
B. Cyclothymia
C. Schizoaffective disorder
D. Delirium
E. Bipolar affective disorder
F. Schizophrenia
G. Depressive episode
H. Pseudodementia

Labile mood, boundless energy, reduced sleep and past history of depression.

E. Bipolar affective disorder

23

A. Manic episode
B. Cyclothymia
C. Schizoaffective disorder
D. Delirium
E. Bipolar affective disorder
F. Schizophrenia
G. Depressive episode
H. Pseudodementia

Anergia, anhedonia, low mood.

G. Depressive episode

24

A. Manic episode
B. Cyclothymia
C. Schizoaffective disorder
D. Delirium
E. Bipolar affective disorder
F. Schizophrenia
G. Depressive episode
H. Pseudodementia

Persistent instability of mood with mild episodes of elation and low mood.

B. Cyclothymia

25

A. Manic episode
B. Cyclothymia
C. Schizoaffective disorder
D. Delirium
E. Bipolar affective disorder
F. Schizophrenia
G. Depressive episode
H. Pseudodementia

Labile mood, boundless energy, reduced sleep. No previous history of mood disorder.

A. Manic episode

26

A. Antidepressant and antipsychotic
B. Cognitive behavioural therapy and antidepressant
C. Supportive counselling
D. Antidepressant
E. Mood stabiliser or antipsychotic
F. Mood stabiliser and antidepressant
G. Electroconvulsive therapy (ECT)
H. Mood stabiliser and antipsychotic

Severe depression with life-threatening anorexia and dehydration.

G. Electroconvulsive therapy (ECT)

ECT can be life-saving in severe depression, since it is a very fast and effective treatment.

27

A. Antidepressant and antipsychotic
B. Cognitive behavioural therapy and antidepressant
C. Supportive counselling
D. Antidepressant
E. Mood stabiliser or antipsychotic
F. Mood stabiliser and antidepressant
G. Electroconvulsive therapy (ECT)
H. Mood stabiliser and antipsychotic

Mild depression.

C. Supportive counselling

Supportive counselling is often sufficient, though mildly depressed patients should still be reviewed to ensure that they are not deteriorating, despite the counselling.

28

A. Antidepressant and antipsychotic
B. Cognitive behavioural therapy and antidepressant
C. Supportive counselling
D. Antidepressant
E. Mood stabiliser or antipsychotic
F. Mood stabiliser and antidepressant
G. Electroconvulsive therapy (ECT)
H. Mood stabiliser and antipsychotic

Moderate depression.

B. Cognitive behavioural therapy and antidepressant

This combination is the ideal, though be aware that CBT waiting lists can be long (e.g. 6 months), so this is not always achievable.

29

A. Antidepressant and antipsychotic
B. Cognitive behavioural therapy and antidepressant
C. Supportive counselling
D. Antidepressant
E. Mood stabiliser or antipsychotic
F. Mood stabiliser and antidepressant
G. Electroconvulsive therapy (ECT)
H. Mood stabiliser and antipsychotic

Psychotic depression.

A. Antidepressant and antipsychotic

Both are required to effectively treat the two aspects of this diagnosis: psychosis and depression.

30

A. Antidepressant and antipsychotic
B. Cognitive behavioural therapy and antidepressant
C. Supportive counselling
D. Antidepressant
E. Mood stabiliser or antipsychotic
F. Mood stabiliser and antidepressant
G. Electroconvulsive therapy (ECT)
H. Mood stabiliser and antipsychotic

Initial treatment of acute mania.

E. Mood stabiliser or antipsychotic

Addictionally, antidepressants and other exacerbating medications should be stopped. A short course of benzodiazepines may be additionally needed for sedation. Is symptoms are severe or don't respond to a mood stabiliser or antipsychotic alone, they may need to be combined.