Formative

Question 1

—A 19 year old student presents to his GP with a three month history of hearing a voice commenting on what he is doing and making derogatory comments about him. It has recently started telling him to do things. He has started to believe that his flatmates are against him and wish to harm him. He uses no illicit drugs.

What is the most likely diagnosis?

—Depression with psychotic features

—Depression without psychotic features

—Drug induced psychosis

—Mania

—Schizophrenia

Answer 1

Schizophrenia - given first rank symptom and lack of drugs or affective symptoms

Question 2

—A 24 year old man is admitted to the acute psychiatric ward with a history of psychotic symptoms and is given a diagnosis of schizophrenia.

Which of the following symptoms is a first rank symptom of schizophrenia?

—Apathy

Confabulation

Nihilistic delusion

Pressure of speech

Thought insertion

Answer 2

Thought insertion

Question 3

—A research student wishes to conduct a project on anxiety disorders and wishes to use a standardised classification system.

Which of the following is the classification system used for mental illness?

—CAGE

ICD-9

ICD-10

SCAN

SCID

Answer 3

ICD-10

Question 4

—An 8 year old boy is referred with behavioural problems to the Child Psychiatry Department. He is always active at home and moves from task to task. He finds it difficult to concentrate to read or watch TV. He often puts himself into dangerous situations like climbing onto high roofs. His performance at school is poor where he is distractible and causes distractions to others.

What is the most likely diagnosis?

—Attention Deficit and Hyperactivity Disorder

Conduct disorder

—Mania

Schizophrenia

Somnambulism

Answer 4

ADHD

Question 5

—An elderly man has been admitted to hospital with acute onset disorientation, visual hallucinations and agitation. He has no psychiatric history and lives alone and requires no support.

What is the most likely diagnosis?

—Alzheimer’s Disease

Delirium

Depression

Lewy Body Dementia

Schizophrenia

Answer 5

Delerium

Question 6

—You are a GP and have diagnosed a 27 year old lady with depression. You are confident that she does not require to be treated in hospital and wish to start her on treatment.

Which of the following would be appropriate first line treatment?

—Benzodiazepines

MAOI

SNRI

SSRI

Tricyclic

Answer 6

SSRI

Question 7

—You are a foundation doctor in an orthopaedic ward in Inverness and a patient with a moderate learning disability is admitted to the ward. The team believe that he does not have capacity to consent to an operation.

Which piece of legislation would be most appropriate to use in this circumstance?

—Adult Support and Protection (Scotland) Act 2007

Adults with Incapacity (Scotland) Act 2000

Mental Capacity Act 2005

Mental Health Act 2007

Mental Health (Care and Treatment)(Scotland) Act 2003

Answer 7

Adults with Incapacity (Scotland) Act 2000

Question 8

—A 29 year old junior doctor is being treated for depression with CBT.

Which of the following is a term used in CBT?

—Interpersonal Map

—Negative Automatic Thoughts

—Pre-contemplation

Separation Anxiety

—Thought Blocking

Answer 8

Negative Automatic Thoughts

Question 9

—A middle aged man is admitted to hospital with gall stones. Part of the admission history is to screen for alcohol problems.

Which of the following is an appropriate questionnaire to screen for alcohol problems?

—BDI

FAST

GCS

MADRS

MOCA

Answer 9

FAST

Question 10

—A 43 year old man is seen in Accident & Emergency after having taken an overdose of Citalopram and Lithium.

Which of the following statements is true?

Lithium has a wide therapeutic index

Lithium is not a suitable treatment for unipolar depression

‘Rebound mania’ is a risk of lithium toxicity

Serum Lithium levels should be measured every 3 months

There is no point continuing lithium if the patient does not show a response within one month

Answer 10

Serum Lithium levels should be measured every 3 months

Question 11

—A 45 year old man is assessed in the outpatient department. He has an intense interest in rare woods and has a very rigid timetable which he sticks to each day. He is upset that the doctor assessing him was 10 minutes late.

What is the most likely diagnosis?

—Autistic Spectrum Disorder

—Delusional Disorder

—Generalised Anxiety Disorder

Obsessive Compulsive Disorder

Paranoid Personality

Answer 11

—Autistic Spectrum Disorder

Question 12

—A 39 year old woman presents with a complaint that she is fearful that something bad may happen to her. This fear occurs where-ever she goes and she cannot describe what might happen. She also complains of pains in her chest, a tremor and sweating at times. What is the most likely diagnosis?

—Bipolar Affective Disorder

—Depression with psychotic features

—Generalised Anxiety Disorder

—Paranoid Personality Disorder

—Schizophrenia

Answer 12

—Generalised Anxiety Disorder

Question 13

—A 33 year old male frequently presents to his GP practice appearing to be under the influence of a substance. He seems quite sedated, has small pupils and complains of constipation. He is also noted to Hepatitis C Virus positive.

What is the most likely diagnosis?

—Acute Alcohol Intoxication

—Acute Cannabis Intoxication

—Cocaine Dependence Syndrome

—Harmful Amphetamine Use

—Opiate Dependence Syndrome

Answer 13

—Opiate Dependence Syndrome

Question 14

—A 67 year old woman arranges for her daughter to be able to manage her money as her own mother developed dementia at the age of 70.

Which is the most appropriate legal power to use in this situation?

—Assessment Order

—Guardianship Order

—Place of Safety Order

—Power of Attorney

—Restriction Order

Answer 14

Power of Attorney

Question 15

—A 28 year old woman with severe depression is admitted to the acute medical assessment ward having taken an overdose. She requires treatment but tries to leave the hospital. The FY2 is the only doctor available. Which is the most appropriate legal power to use in this situation?

—Compulsory Treatment Order

—Emergency Detention Certificate

—Place of Safety Order

—Restriction Order

—Short Term Detention Certificate

Answer 15

Emergency Detention Certificate

Question 16

—A 24 year old man has recently been started on new medication by his psychiatrist. One of the side effects is an unpleasant sensation of restlessness.

What is the correct term for this?

—Akathisia

—Anhedonia

—Catatonia

—Dysarthria

—Dystonia

Answer 16

Akathesia

Question 17

—A 28 year old man has recently started on antipsychotics. He has been told about a side effect of muscle stiffness and contraction sometimes caused by antipsychotics.

What is the correct term for this?

—Agraphia

—Akathisia

—Catatonia

—Dyscalculia

—Dystonia

Answer 17

Dystonia

Question 18

—A 34 year old man develops depression and suffers the inability to experience pleasure but can experience other emotions.

What is the correct term for this?

—Alexithymia

—Anergia

—Anhedonia

—Cyclothymia

—Poverty of Thought

Answer 18

Anhedonia

Question 19

—A 68 year old woman has been diagnosed with severe depression. One of the symptoms is that she believes her bowels are rotting.

What is the correct term for this?

—Confabulation

—Grandiose Delusion

—Hallucination

—Ideas of Reference

—Nihilistic Delusion

Answer 19

Nihilistic delusion

Question 20

—A 22 year old man with no previous psychiatric illness sees a street lamp flicker and suddenly knows that he is the next Scottish ambassador to Wales.

What is the correct term for this?

—Confabulation

—Delusional Perception

—Nihilistic Delusion

—Thought Broadcasting

—Visual Hallucination

Answer 20

Delusional perception

Question 21

—A 23 year old man experiences irritability, grandiose delusions and a reduced need for sleep. He has previously been in a psychiatric hospital treated for depression.

Which is the most likely diagnosis?

—Anxious/Avoidant Personality Disorder

—Attention Deficit and Hyperactivity Disorder

—Bipolar Affective Disorder

—Delusional Disorder

—Schizophrenia

Answer 21

Bipolar affective disorder

Question 22

—A 24 year old woman who has a one month history of low mood, early morning wakening, irritability, reduced appetite and some suicidal thoughts. She also feels guilty that she feels too tired to take her two year old daughter to nursery.

Which is the most likely diagnosis?

—Agoraphobia

—Anorexia Nervosa

—Depression

—Postnatal Depression

—Postpartum Psychosis

Answer 22

Depression

Postnatal depression must be within 6 months of delivery

Question 23

—A 79 year old man who has had two hospital admissions for depression in the past is brought to the GP by his daughter. She is concerned that he is spending lots of money, has a reduced need to sleep, is full of energy and wants to run a marathon.

Which is the most likely diagnosis?

—Alzheimer’s Disease

—Bipolar Affective Disorder

—Delusional Disorder

—Lewy Body Dementia

—Vascular Dementia

Answer 23

Bioplar affective disorders

Question 24

—You are a psychiatrist treating a 34 year old woman with depression. You are confident of the diagnosis. You have already tried two antidepressants and the second has had only partial effect. Her mood has lifted slightly but she complains of poor sleep, lack of energy and motivation and poor appetite.

Which of the following is the most appropriate next step?

—Add amphetamine based stimulant drugs

—Add lithium

—Add thyroxine

—Psychosurgery

—Stop the medication

Answer 24

Add lithium

Question 25

—A 28 year old woman is an inpatient in the general adult ward. She is being treated for schizophrenia and her symptoms are improving on medication. She is allowed to go to the cinema with a friend and on return to the ward is convinced the nurses have been replaced by aliens, the radio is playing songs especially for her and she can hear voices telling her to sit up all night.

What is the most appropriate investigation to order?

—Blood glucose

—CT Scan

—Full Blood Count

—Temperature

—Urinary drug screen

Answer 25

Urinary drug screen