BB Questions Flashcards
A 23-year-old man has recovered from his second episode of schizophrenia. Six months after discharge from inpatient care, he is symptom-free, and insists on stopping all his antipsychotic medication. He lives with his parents in what the clinical team have judged to be a high expressed emotion household. If he goes ahead and stops his medication, what is the probability that he will experience a relapse within nine months?
80%
While giving his past psychiatric history, a 45-year-old man says that he was treated for depression in the past with medication. He cannot remember the name of the medication, but said that he recalls that when he started taking it, he experienced gastrointestinal discomfort. Also, he started taking it at night but had to switch to taking it in the morning because taking it at night disturbed his sleep even more than the depression itself had done. Which of the following medications is most likely to be the one he was taking?
Citalopram
A 24-year-old man presents with what appears to be an acute psychotic episode. Which of the clinical features below is most likely to discriminate between this being a schizophreniform psychosis or a manic episode?
The presence of delusions that are incongruent with the patient’s mood
A general practitioner refers a 20-year old woman for specialist assessment, stating that she has a phobia. Which of the following features is most likely to indicate a diagnosis of social phobia as opposed to agoraphobia
Fear of blushing in public
A 15-year old girl is brought to her general practitioner by her mother, who suspects that her daughter has an eating disorder. Which of the following features makes it more likely that the daughters diagnosis is bulimia, as opposed to anorexia?
A body-mass index of 18
A 22-year old man presents to his general practitioner with a history of gradually increasing concern about contamination. He worries for much of the day that he has become infected by bacteria, and reports that he has to wash his hands thoroughly whenever he touches objects that he thinks are dusty. He has a particular routine that he must follow when washing his hands and if this routine is interrupted, he must begin the routine again. What term best describes his hand-washing specifically?
Compulsion
An 18-year old girl presents in the Accident and Emergency Department following an overdose of aspirin tablets. It appears that this was an impulsive gesture, in front of her boyfriend, during the course of an argument. She and her boyfriend had been drinking, but on examination, she did not appear intoxicated. Examination revealed no specific mental state abnormalities, and she denied wanting to kill herself. Statistically, what is the probability that she will present again with another episode of self-harm within the next 12 months?
20%
A 22-year old man comes to the local general practice, asking to be signed on as a temporary patient. The circumstances of his presentation make the doctor suspect that the patient is abusing drugs. As he comes into the consulting room, the doctor notices that he seems to be sweating, has a runny nose and dilated pupils. Such symptoms are associated with withdrawal from one of the following drugs. Which one?
Heroin
An 82-year old woman is brought by her daughter-in-law to the general practitioner. Mental state examination reveals that she shows considerable cognitive impairment. Which of the following features would suggest that this presentation is of Alzheimer-type dementia rather than multi-infarct (vascular) dementia?
A history of a gradual decline in her cognitive state
You are a medical house officer, asked to assess a 76-year old man, recently admitted to the medical ward because he had become cachectic, presumably because he was neglecting himself. His mental state fluctuates markedly. At times, he appears lucid, while at other times he is very distressed and appears to be responding to auditory and visual hallucinations. During his lucid times, he can find his way without difficulty to the toilet and back to his bed. When he is distressed, he easily gets lost on his way to or from the toilet. What should be the main focus of his management?
Conduct a thorough physical examination and investigations to identify an underlying organic cause for the presentation
A 32-year old man presents to his general practitioner with a 5-week history of worsening low mood, which he attributes to tensions within his marriage. On direct questioning, he admits that he finds it very difficult to concentrate on his work, and finds no interest in it. He routinely wakes 3 hours before he was accustomed to previously, and feels unrefreshed when he wakes. He now feels hopeless about the future, and says that life isnt worth living, although on questioning, he has made no plans to end his life. Direct questioning reveals no relevant past or family history. Physical examination reveals no abnormalities. What would be the most appropriate management plan?
Prescribe fluoxetine 20 mg once a day and ask him to return for review in a week’s time
A 45-year old man is brought to Accident and Emergency, having collapsed in a local pub. The ambulance crew state that others in the pub said the man had been drinking heavily, on his own, for some hours, and then had what appears to have been a fit. When you assess him once he has sobered up, he reports that his wife and children left him two weeks earlier, and that he lost his job six months ago because of his drinking. He admits that he has to have a large tot of whisky each morning before he gets out of bed. He has undergone a detoxification regime twice before, once with his general practitioner and once with a specialist alcoholism service. On both occasions, he started drinking again within three weeks of ending the regime. Initial investigations include a raised mean corpuscular volume. What is the most appropriate immediate management plan?
Admit him for medical observation, starting him on a descending regime of chlordiazepoxide, plus vitamin B1
A 20-year old man has just been discharged from inpatient psychiatric care. He has a definitive diagnosis of schizophrenia. There were no conspicuous precipitating factors apart from stress from his work at university. In particular, he has never taken illicit drugs, and there is no family history of psychosis. He has a non-identical twin brother. What is the lifetime risk of his twin developing schizophrenia?
10%
Among patients on an acute medical inpatient ward, what is the likely prevalence of clinical depression?
25%
A 16-year old boy is referred to Child and Adolescent Mental Health Services. His parents describe a 4-month history of increasingly bizarre behaviour, disorganised speech, and incongruent affect. On direct questioning, the boy himself admits to hearing voices, and also expresses delusional beliefs. He is diagnosed as having a psychotic episode. What is the overall probability that he will recover fully from this episode and experience no further relapses of psychosis?
20%
A 20-year old man has been referred by his general practitioner for specialist mental health assessment. He says that people are talking about him all the time, especially when he turns on the television. He believes that the flight path of aircraft have been specially changed so that they fly over his home, and interfere with his brain waves. He complains that he cannot sleep at night because people come into his flat and talk incessantly. He admits that everything that is happening to him is making him feel depressed. The psychiatrist makes a working diagnosis, and prescribes some medication. Which medication would be most appropriate in these circumstances?
Olanzepine
Published research evidence supports the effectiveness of a number of interventions in bulimia nervosa. Which of the following interventions has to date not been supported by robust research evidence?
Psychoanalytic Psychotherapy
An 18-year old woman presents in Accident and Emergency having taken an overdose of aspirin tablets. Which of the factors below indicate a particularly increased risk of a further overdose in the future?
That she was seen in A&E following another overdose a few months previously
Answers:
Under the Mental Health Act (1983), who can make an application to have a patient admitted to an inpatient psychiatric unit under Section 2 or 3?
An Approved Social Worker
ou are a general practitioner, asked to see an 8-year old boy by his mother, because he has been bed-wetting. Examining the child, you notice several bruises, at different stages of resolution, on the boys arms, and a burn mark on his back, the size of which is consistent with being burned by a lighted cigarette. The mothers explanation for these injuries appears implausible, and you suspect that the boy is being abused. What do you do?
Report your concerns to Social Services
A 23-year old woman presents in the Accident and Emergency Department with what appears to acute appendicitis, and a decision is taken to recommend appendectomy. She is accompanied by her mother, who says that her daughter has a learning disability. Although the daughter now lives independently, she attended a special school because of her learning difficulties. The mother does not think that her daughter will understand the need for surgery. What would be the most appropriate course of action?
Correct Explain to the patient what is considered to be the problem, and the need for surgery, to ascertain whether she can give informed consent
A care home for the elderly contacts you as the local general practitioner to see an 86-year old widow who was previously frail but otherwise quite well, but now presents with a 3-day history of confusion. Talking with staff, you learn that she sometimes cannot find her way to the dining room, or back to her own room, and sometimes appears to mis-recognise people she has known for a long time. However, at other times, she appears to be her normal self. The home is finding her behaviour increasingly difficult to cope with. What would be your most appropriate initial response to this situation?
Carry out a physical examination, blood tests and urine screen to try to identify a physical cause for the patient’s presentation
A 38-year old man comes to see you, his general practitioner, because of persistent gastrointestinal pains. You think his symptoms are likely to be due to a gastric ulcer. You elicit a history of binge-drinking with friends in the local pub at weekends, but the patient insists that he drinks only two cans of lager each evening during the week. He denies having to drink first thing in the mornings, or experiencing craving to drink during weekdays. What would be your most appropriate response to the psychiatric component of this history?
Counsel him about the harmful effects of drinking alcohol, and about safe limits of alcohol intake
You are asked, as a house officer, to assess a man in his 50s who has recently been admitted to an acute medical ward from the Accident and Emergency Department. Nursing staff are concerned that he appears to be disoriented. On examination, you note that, amongst other signs, he has a horizontal nystagmus, and some difficulties in heel-toe walking. What is the most likely diagnosis?
Wernicke’s encephalopathy
A 26-year old woman on antidepressant prophylaxis following successful treatment of a first episode of depression six months previously, presents at a follow-up appointment at the local community mental health team with a two-week history of expansive mood and great confidence, feeling on top of the world, having boundless energy, and requiring hardly any sleep. What would be the most appropriate immediate intervention?
Discontinue her antidepressant medication, and start her on lithium carbonate
A 28-year old woman lives in supported accommodation. She is able to manage most tasks of self-care, but needs help with taking her medications (in the form of a dosette box, filled by a carer). She has a flat occiput, and short, broad hands. On the basis of this information, what is the likelihood that she has an IQ under 50 and has multiple associated physical abnormalities?
10%
A 42-year old man with a 25-year history of schizophrenia has been on regular monthly injections for approximately 18 years. This medication regime has been kept unchanged, because his mental state has been stable, and he has not had any positive symptoms of schizophrenia. The community mental health team consider that he would probably take oral medication as directed, but he has preferred to remain in the injections. However, he now presents with repetitive involuntary movements of his mouth and tongue, which have become progressively worse over the past two months or so. What would be the most appropriate intervention?
Discontinue the depot antipsychotic medication and start him on oral olanzepine
A 18-year old girl presents to a general psychiatry outpatient clinic. She has had what her mother describes as an eating problem for some years, but it has become considerably worse over the past year. She has lost considerable weight, and at the clinic, her weight is 40 kg and her Body Mass Index is 15 kg/m2. She admits that she is very fastidious about her food, carefully choosing what to eat, and disregarding her mothers advice. She goes to the gym daily for a work-out lasting at least 90 minutes. Her periods had been regular, but she has had none for the last 3 months. At the appointment, she is accompanied by her mother, who is clearly exasperated by her daughters behaviour, and expresses considerable criticism of her. What would be the most appropriate initial intervention?
Refer her to a specialist eating disorders clinic, so that she can receive a combination of nutritional advice, individual and family therapy
A 19-year old woman is on the post-natal unit, having given birth to her first baby (at term) three days earlier. There were no complications during pregnancy or labour, but the baby is not feeding well (breast-feeding proved very difficult, and the baby is now being fed by bottle). During antenatal care, she told the midwives that her father told her that her own mother was never quite the same after giving birth to her (she is an only child). Three days after delivery, the woman tells the midwife that she is very worried that there is something seriously wrong with the baby, and over the next 24 hours, she is constantly seeking reassurance that the baby is alive and well. She is very tearful, and her mood appears to fluctuate considerably. When her partner visits, she snaps at him. Which of the statements below most accurately describes this presentation?
The patient is likely to have ‘the baby blues’, should be reassured and the clinical picture monitored over time
A 45 year old man seeks help from his general practitioner. He has never had paid employment but, having left school, devoted himself to looking after his widowed mother who had severe arthritis and was virtually housebound. She died 6 months ago, and he now feels that his life is empty. He thinks about his mother a great deal, and feels guilty that he could not do more to help her in the months before her death. On further questioning, he admits that he has felt this emptiness since childhood, and has never made friends, but has always been a loner. Which of the details below suggest that he has a personality disorder?
His comment that his feelings of emptiness have been with him since childhood
A 67 year old man is visited at home by his GP who finds him in squalor, grossly self neglected and expressing ideas that his heart is ‘rotten’ and he believes he is guilty of genocide by causing crops to fail in Africa.
Depression with psychotic features
A 25 year old man says his thoughts are being controlled and that people are reading his thoughts. For the past 2 weeks he has been convinced of a conspiracy against him by his previous employer and he feels certain there are messaged from this person in the newspaper headlines
Paranoid schizophrenia
A 32 year old man talking quickly with lots of ideas that are difficult to follow. He expresses ideas that he has special powers and can control the weather.
Mania/Hypomania
An 80 year old woman is brought to the Accident and Emergency Department with acute shortness of breath. From her history, it appears that she is in heart failure. She knows her name, but thinks she’s in her local church, and that the doctor is a visiting priest
Acute organic brain syndrome (delirium)
A 25 year old man is brought for an assessment by his parents. They give a history of deterioration in social functioning over the past 4-5 months. On examination, the patient displays affect that does not seem to fit with the conversation, and seems to move from one topic to another in an illogical manner.
Hebephrenic Schizophrenia
A man holds a strange pose that looks uncomfortable, bending half way over, and when you examine him you notice you can move his limbs to other positions, which he doesn’t resist and he then hold the pose you put him in until you move him again.
Catatonic symptom
