Pastest - PSYCHIATRY

Question 1

What are the objective signs of opioid withdrawal?

Answer 1

dilated pupils, yawning, rhinorrhoea (nose running), eiphoria (eyes watering)

Question 2

Which med is used to treat hypersalivation in clozapine-treated patients?

Answer 2

hyoscine

Question 3

A 60-year-old male is admitted to the in-patient psychiatric unit last night. On reviewing him this morning, he is a poor historian, answering most questions minimally and stating he does not need to be here as he is deceased, and hospitals should be for living patients.

What is the name of this delusional disorder and which condition is it most commonly associated with?

Answer 3

Cotard syndrome and major depressive disorder

Question 4

You have been asked to review a patient with chest pain awaiting assessment by the psychiatry team.

Examination and investigations are normal, however, you note that he is acting strangely. He is reluctant to answer questions and does not maintain eye contact. After developing trust with him, he discloses he has never been in a relationship and that he prefers to be on his own as he won’t embarrass himself. He has no friends and doesn’t speak to his family because they criticise everything he does.

Which form of personality disorder is he likely suffering from?

Answer 4

Avoidant

Question 5

A 29-year-old man is on the psychiatric ward under section 2 of the mental health act for suspected schizophrenia. He has a 3-month history of increasing suspicion of his family and had recently begun to collect weapons to defend himself. He started olanzapine 2 weeks ago. He has no other medical conditions and takes no other medications.

Today staff on the ward raised concerns due to his abnormal behaviour. He was found in his room sat on the floor with his back arched and legs hunched upwards. It is reported that he has been like this for the last 2 hours. His observations are normal. He has not spoken or made any movements during this time.

Which of the following best describes his current presentation?

Answer 5

Catatonia = stopping of voluntary movement or staying still in an unusual position

Question 6

A 64-year-old male who has been on long term chlorpromazine presents with repetitive eye blinking. He reports he is unable to control this and is worried about what might be causing it. He is otherwise well in himself and has no visual disturbance. He has a normal facial and ocular examination with the exception of excessive rapid blinking.

What is the most likely cause of his symptoms?

Answer 6

tardive dyskinesia: can present as chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary choreoathetoid movements in patients on conventional antipsychotics

Question 7

A 23-year-old man presents to the emergency department following a recent diagnosis of migraine by his GP. He describes the headaches as right-sided, lasting around 6 hours, and brought on by work stress. He often feels nauseated with the headaches which resolve when he lies in a quiet room. He has a past history of depression and takes sertraline. He has no allergies. Neurological examination is unremarkable. The doctor reviewing him is concerned about a medication he has started for his symptoms.

What is the medication that the doctor is most likely to be concerned about in this patient?
Options:
1. ibuprofen and omeprazole
2. metoclopramide
3. paracetamol
4. prochlorperazine
5. sumatriptan

Answer 7

sumatriptan - triptans should be avoided in patients taking a SSRI

Question 8

when does delirium tremens tend to occur?

Answer 8

48-72 hours after acute alcohol withdrawal

Question 9

what is the most appropriate next step in management of more severe OCD which is unresponsive to CBT/exposure and response prevention?

Answer 9

Add an SSRI eg sertraline or fluoxetine

Question 10

What is dialectical behaviour therapy (DBT) and when is it indicated?

Answer 10

focuses primarily on emotional regulation and is predominantly used in patients with emotionally unstable personality disorder (EUPD)

Question 11

What is EMDR and when is it indicated?

Answer 11

eye movement desensitisation and reprocessing
predominantly used in PTSD

Question 12

What type of urinary incontinence is the most associated with amitriptyline?

Answer 12

overflow incontinence - associated with tricyclic antidepressants

Question 13

What are confabulations?

Answer 13

fabrications of imaginary experiences due to loss of memory - common phenomenon in patients with significant cognitive impairment eg dementia

Question 14

A patient presents with complaints of involuntary muscle movements of her tongue, fingers and trunk for the past 2 months. She was diagnosed with schizophrenia 5 years ago and has been on flupenthixol and the haloperidol with good compliance. There is pronounced choreoathetoid movement. What is the next line of management of this patient?

Answer 14

stop the haloperidol and start olanzapine

Question 15

which axis is involved in the pathophysiology of anxiety disorders, panic disorder and PTSD…?

Answer 15

hypothalamic pituitary adrenal axis (HPA)

Question 16

Which Questionnaire is used to monitor response to treatment in patients with depression?

Answer 16

patient health questionnaire (PHQ-9)

Question 17

What is schizoid personality disorder?>

Answer 17

disorder where patient has a long history of loneliness, odd behaviours and flat affects
they do not have any weird/magical thinking (schizotypal) or psychotic symptoms (schizophrenia, schizoaffective disorder)

Question 18

which blood investigations can be used for assessing alcohol intake?

Answer 18

mean corpuscular volume
LFTs
gamma glutamyl transferase

Question 19

what is the level for lithium toxicity?

Answer 19

levels above 1.5 mmol/l

Question 20

what is the mechanism of action of duloxetine?

Answer 20

serotonin and noradrenaline reuptake inhibitor

Question 21

what is used to treat delirium tremens/alcohol withdrawal?

Answer 21

chlordiazepoxide or diazepam

Question 22

what are the criteria in ICD-10 for mania?

Answer 22

elated mood/occasional irritability
increased energy
psychotic symptoms (?)
to diagnose need at least 3 of DIGFAST:
D – distractibility/inability to sustain attention
I – indiscretions/impulsivity/loss of social inhibitions/aggression (excessive pleasurable activities, risky sexual behaviour, drug taking, fast driving)
G – grandiosity (mood congruent – as elated)/extravagance
F – flight of ideas– difficult to interpret
A – activity increase/excessive optimism
S – sleep deficits/decreased need for sleep
T – talkativeness/pressure of speech

Question 23

what is hypomania according to ICD-10?

Answer 23

lesser degree of mania but too persistent and marked to be cyclothymia
features:
elated mood, increased energy and activity
Feeling of mental and physical wellbeing and efficiency
Increased sociability, overfamiliarity, sexual drive
Decreased need for sleep
Irritability
NO PSYCHOTIC SYMPTOMS, OR DISRUPT TO WORK/SOCIAL ACTIVITIES

Question 24

What is the difference between hypomania and mania?

Answer 24

hypomania has no psychotic symptoms and it does not disrupt work/social activities

Question 25

What medication is good to use for children or adults with learning difficulties who have irregular natural sleep-wake cycles?

Answer 25

melatonin

Question 26

What are some of the sudden discontinuation symptoms from abruptly stopping SSRIs?

Answer 26

rebound anxiety or depressive symptoms, flu-like symptoms, dizziness, nausea or sleep disturbances

Question 27

When is EMDR (eye movement desensitisation and reprocessing) not used in PTSD? What would be used instead?

Answer 27

EMDR is recommended treatment of PTSD, except in the case of combat-related trauma - instead trauma-focused CBT would be used

Question 28

A 19 year old woman presents to her GP with a 3 year history of restricting food intake and self-induced vomiting. She attends her GP for the first time with her sibling reporting a recent worsening of her symptoms. The GP suspects anorexia nervosa. What is the most appropriate investigation to determine whether the patient requires urgent hospital admission?

Answer 28

ECG
for any cardiovascular instability, including assessment of HR, along with assessment of the QT interval

Question 29

What is factitious disorder?

Answer 29

refers to a patient with no physical or organic disease but who finds satisfaction in taking on the ‘sick role’ and wants to be taken care of

Question 30

What is factitious or induced illness?

Answer 30

similar to factitious disorder but involves a patient seeking the ‘sick role’ vicariously through a second patient
*think about the film ‘the act’ where the mother suffering from factitious disorder will abuse her child so that she can bring the child to the doctor for treatment

Question 31

What is conversion disorder?

Answer 31

refers to manifestation of psychological illness or neurologic pathology. These patients suffer from weakness, numbness, blindness or paralysis as symptoms of an underlying psychiatric illness

Question 32

What is zopiclone used for?

Answer 32

used as a hypnotic to help people sleep.

Question 33

An 18 year old male student spontaneously disrobed while watching a film. He saw wavy lines on the screen and then reported a brief episode of mental blankness, followed soon after by a headache and extreme fatigue. What is the most likely diagnosis?

Answer 33

Partial complex seizure or Focal Impaired Awareness epilepsy

Question 34

What needs to be monitored when giving a patient Clozapine?

Answer 34

there is up to 2% risk of developing agranulocytosis (lowered WBC) therefore WBC should be monitored
clozapine can cause bone marrow suppression leading to lowered WBC count and increasing the risk of infection in these patients

Question 35

A 50 year old woman is brought in by her son because she is acting ‘wild’ again. She drinks moderately about once a week. She is not sleeping much, talks incessantly about plans to read the great books and has made many impulsive and irrational purchases. She reports hearing voices but refuses to discuss this issue when questioned by the admitting psychiatrist. She begins a task but does not complete it, all the while making lists of things to be done. She has been starting tasks and not finishing them. She had a similar episode 4 years ago. She also has depressive episodes several times over the last few years and recovered in between them. What is the most likely underlying diagnosis?

Answer 35

bipolar, manic, with mood-congruent psychotic features

Question 36

What is schizophreniform disorder?

Answer 36

symptoms of schizophrenia of <6 months duration

Question 37

What is schizoaffective disorder? Which patients are excluded from this diagnosis?

Answer 37

Features of both schizophrenia and affective disorder (e.g. depression, mania, mixed), present in approx. equal proportion - lasting considerable part of at least 1 month
Exclude patients:
With separate episodes of SZP or mood disorders; In the context of substance use or other medical disorder (organic cause)

Question 38

What is the term for the repetition of someone’s speech?

Answer 38

echolalia

Question 39

What is the difference between knight’s move and flight of ideas?

Answer 39

Knight’s move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas

Question 40

A 20 y.o. first time mother presents with severe weight loss, anorexia and believes that her husband is interested in killing her and their baby son and feels completely worthless. What is the single most appropriate treatment option?
Clozapine
CBT
fluoxetine
lithium
monitor at home

Answer 40

fluoxetine

Question 41

A 40 y.o. man has been treated for depression for 3 months. He is now beginning to lose weight and getting suicidal thoughts more frequently than before. What is the single most appropriate treatment option?
ECT
flupnethixol
no action
psychodynamic psychotherapy
sertraline

Answer 41

sertraline

Question 42

A 29 y.o. woman presents with new-onset inability to sleep, excessive spending and increased libido. What is the single most appropriate treatment option?
behavioural activation
citalopram
counselling
quetiapine
ECT

Answer 42

quetiapine

Question 43

An 18 y.o. girl with a BMI of 15 complains of three month history of amenorrhoea. She is not on the pill and the pregnancy test is negative. She wants to be a model. What is the single most appropriate next step in management?
assess physical state
citalopram
food diary
olanzapine
supplement drinks

Answer 43

assess physical state

Question 44

A 20 y.o. man keeps cleaning his hands every time he shakes his partner’s hands. He was a high achiever in high school. What is the single most likely diagnosis?
anakastic personality disorder
borderline personality disorder
dependent personality disorder
avoidant personality disorder
schizoid personality disorder

Answer 44

anakastic personality disorder

Question 45

what is anankastic personality disorder?

Answer 45

another term for obsessive compulsive personality disorder

Question 46

A 56 y.o. farmer believes that his neighbour is killing his farm animals despite the local veterinary’s advice that the death is due to an outbreak of anthrax. He spends hours watching his neighbour through pair of binoculars, hoping to catch him in the act. What is the single most likely diagnosis?
anankastic personality disorder
borderline personality disorder
histrionic personality disorder
paranoid personality disorder
schizotypal personality disorder

Answer 46

paranoid personality disorder

Question 47

A 23 y.o. student presents with insomnia, headaches, sweating, palpitations, chest pain and poor appetite. What is the single most likely diagnosis?
alcohol dependency
generalised anxiety disorder
schizophrenia
social phobia
somatisation disorder

Answer 47

generalised anxiety disorder

Question 48

A 35 y.o. single woman presents with a 3 month history of weight loss, poor appetite, decreased ability to concentrate and guilt feelings. What is the single most likely diagnosis?
depression
hypomania
obsessive compulsive disorder
post-traumatic stress disorder
schizophrenia

Answer 48

depression

Question 49

A 19 y.o. female student was at her fathers funeral last week. She presents with sudden onset of blindness. Neurologic examination reveals no abnormality. What is the single most likely diagnosis?
conversion disorder
depersonalisation
hypochondrial disorder
obsessive compulsive disorder
schizophrenia

Answer 49

conversion disorder

Question 50

A 20 y.o. man presents with disinhibition, hyperactivity, increased appetite and grandiose delusions over the past 2 weeks. What is the single most likely diagnosis?
adjustment disorder
ADHD
depressive episode
mania
schizophrenia

Answer 50

mania

Question 51

What does disinhibition mean?

Answer 51

can be defined as the inability to withhold a prepotent response or suppress an inappropriate or unwanted behaviour. It can refer to the production of socially inappropriate comments and/or actions

Question 52

A 31 y.o. man presents with auditory hallucinations, social withdrawal and delusions of persecution. What is the single most likely diagnosis?
alcohol dependency
bipolar affective disorder
depersonalisation
paranoid schizophrenia
persistent delusional disorder

Answer 52

paranoid schizophrenia

Question 53

A 22 y.o. man presents with compulsions and rituals, which he attempts to resist, but he is unable to do so. What is the single most likely diagnosis?
depersonalisation
dissociative disorder
obsessive compulsive disorder
post-traumatic stress disorder
schizophrenia

Answer 53

obsessive compulsive disorder

Question 54

A 71 year old retired engineer experiences changes in personality and impaired social skills. His family, who describe him as forgetful and not as sharp, corroborates this. There are no objective features of depression. What is the single most likely diagnosis?
adjustment disorder
fronto-temporal dementia
late onset schizophrenia
panic attacks
social phobia

Answer 54

fronto-temporal dementia

Question 55

A 20 y.o. man is noted to be withdrawn, isolated and peculiar. He has persecutory beliefs gangsters are out to get him and says he hears them talking about him, when no one else can hear them. What is the single most likely diagnosis?
delirium
depression with psychotic symptoms
hypomania
panic disorder
paranoid schizophrenia

Answer 55

paranoid schizophrenia

Question 56

An 80 y.o. widow is noted by her family, over the past 3 months, to be restless and often crying. She frequently says she wants to die. What is the single most likely diagnosis?
alcohol dependence
Alzheimers dementia
delirium
depression
generalised anxiety disorder

Answer 56

depression

Question 57

A 40 y.o. cyclist complains of frequent episodes of chest pains, sweating, palpitations, a sense of impending doom and trembling that lasts for minutes at a time. What is the single most likely diagnosis?
angina
generalised anxiety disorder
hypochondrial disorder
panic disorder
social anxiety disorder

Answer 57

panic disorder

Question 58

A 25 y.o. man presents with miosis, slurred speech, disorientation, and respiratory depression. What is the single most likely diagnosis?
alcohol intoxication
amphetamine overdose
opiate overdose
paracetamol overdose

Answer 58

opiate overdose

Question 59

A 70 y.o. man presents with progressive forgetfulness and mood changes. He has a shuffling gait and visual hallucinations at night. These have been present for 1 year. The head CT scans shows cortical atrophy and enlarged ventricles. What is the single most appropriate treatment option?
co-beneldopa
diazepam
procyclidine
risperidone
rivastigmine

Answer 59

rivastigmine

Question 60

A 60 y.o. man presents with a disturbance of voluntary motor function. His face is expressionless. On examination he has cogwheel rigidity and bradykinesia. He has no cognitive impairment. What is the single most appropriate treatment option?
co-beneldopa
diazepam
procyclidine
risperidone
rivastigmine

Answer 60

co-beneldopa

Question 61

A 40 y.o. accountant presents with acute confusion. He is seeing spiders crawling on his arms and has a broad based gait on physical examination. What is the single most appropriate treatment option?
acamprosate
chlordiazepoxide
diazepam
disulfiram
pabrinex

Answer 61

pabrinex

Question 62

what is in pabrinex and what is it used for?

Answer 62

Thiamine and ascorbic acid
used for treatment of suspected or established Wernicke’s encephalopathy

Question 63

A 23 y.o. female presents with constant low mood and irritability. She thinks regularly about suicide. She has trouble sleeping and has lost her appetite. Her father died four weeks ago. What is the single most likely diagnosis?
abnormal grief reaction
adjustment disorder
depressive disorder
dysthymia
PTSD

Answer 63

abnormal grief reaction

Question 64

A 30 y.o. female complains of depression, lethargy, constipation, and weight gain. She also suffers from menorrhagia. What is the single most likely diagnosis?
alcohol abuse
bipolar affective disorder
bulimia nervosa
hypochondrial disorder
hypothyroidism

Answer 64

hypothyroidism

Question 65

A 40 y.o. woman presents with depression and weight gain. She complains of back pain and excessive thirst. Her menstrual period lasts for three days and sometimes she skips a cycle. On examination she is obese with acne and peripheral oedema. What is the single most likely diagnosis?
Addison’s disease
Cushing’s syndrome
hyperparathyroidism
porphyria
recurrent depressive disorder

Answer 65

Cushing’s syndrome

Question 66

A 30 y.o. female on the OCP presents with colicky abdominal pain, vomiting, and depression. She is noted to be hypertensive. She reports that her urine turns deep red if left to stand during these episodes. What is the single most likely diagnosis?
Cushing’s syndrome
drug abuse
hyperthyroidism
hypothyroidism
porphyria

Answer 66

porphyria

Question 67

A 33 y.o. female presents to the GP with chronic feelings of isolation and hopelessness. She struggles to maintain relationships and finds the only effective coping method to relieve her distress is to make superficial cuts to her forearm. What is the single most likely diagnosis?
anankastic personality disorder
borderline personality disorder
dependent personality disorder
histrionic personality disorder
narcississtic personality disorder

Answer 67

borderline personality disorder

Question 68

A 42 y.o. man insists that his wife is unfaithful and sleeping with most of the local neighbourhood. He is hypersensitive, argumentative and litigious. His wife has left him due to his behaviour. He functions well at work. What is the single most likely diagnosis?
Capgras syndrome
Cotards syndrome
De Clerambault syndrome
Foliea deux
Othello syndrome

Answer 68

Othello syndrome

Question 69

A 26 y.o. woman presents with irritability and insomnia for the past 3 weeks. 2 years ago she had severe depression with low self-esteem and suicidal thoughts. When she is interviewed, she presents with pressured speech. What is the single most likely diagnosis?
bipolar affective disorder
delusional disorder
paranoid schizophrenia
recurrent depressive disorder

Answer 69

bipolar affective disorder

Question 70

A 20 y.o. woman feels that she has no need for sleep. She has reached her credit card limit on recent shopping spree. Her appetite is unaffected. She has no psychotic symptoms. She continues to work in her job as a receptionist. What is the single most likely diagnosis?
amphetamine use
bipolar affective disorder
hypomania
meningioma
schizoaffective disorder

Answer 70

hypomania

Question 71

A 20 y.o. woman presents to her GP complaining of feeling depressed ever since she can remember. She sees herself as a failure but functions well at work. She has trouble falling sleep. What is the single most likely diagnosis?
body dysmorphic disorder
dysthymia
generalised anxiety disorder
paranoid schizophrenia
recurrent depressive disorder

Answer 71

dysthymia

Question 72

A 19 y.o. man presents with nausea, vomiting and sweating. His pupils are dilated and his BP is elevated. He has a history of drug addiction. What is the single most likely diagnosis?
alcohol intoxication
alcohol withdrawal
cannabis intoxication
cocaine intoxication
opioid withdrawal

Answer 72

cocaine intoxication

Question 73

A 30 y.o. woman is found in an amnesic state. Her sister reports that she had been missing for a few days after she has been served with divorce papers. What is the single most likely diagnosis?
alcohol intoxication
alcohol withdrawal
delirium
dementia
dissociative fugue

Answer 73

dissociative fugue

Question 74

A 30 y.o. man with bipolar disorder is taking lithium. He was recently started on thiazide diuretics for mild hypertension. He is now confused with ataxia, blurred vision and a coarse tremor. What is the single most likely diagnosis?
alcohol withdrawal
lithium toxicity
opioid withdrawal
renal failure
thyrotoxicosis

Answer 74

lithium toxicity

Question 75

Which class of drug have the Medicines and Healthcare products Regulatory Agency warned may be associated with an increased risk of venous thromboembolism in elderly patients?

Answer 75

atypical antipsychotics - in the elderly has increased risk of stroke and VTE

Question 76

What are some examples of atypical antipsychotics?

Answer 76

clozapine, risperidone, olanzappine

Question 77

what are some examples of typical antipsychotics?

Answer 77

haloperidol and chlopromazine

Question 78

What is one symptom or sign that may be exhibited on withdrawal of heroin for the following categories: neurological, psychological, gastrointestinal and dermatological?

Answer 78

neurological: agitation, paraesthesia and dilated pupils
psychological: depression, craving
gastrointestinal: diarrhoea, vomiting, abdominal cramps
dermatological: sweating, ‘goose bumps’

Question 79

the long-term use of which of the following causes hyperparathyroidism and resultant hypercalcaemia?
amitriptyline
clozapine
lithium
sertraline
sodium valproate

Answer 79

lithium

Question 80

A 45 y.o. man describes successful abstinence from alcohol for the past six months following inpatient detoxification. During his admission, he was started on a ‘deterrent’ medication. He takes this medication daily and reports that if he consumes alcohol he will ‘violently vomit’. Which medication is the patient describing?

Answer 80

Disulfiram - with alcohol induces facial flushing, nausea and vomiting. Disulfiram is used as a deterrent to prevent alcohol relapse

Question 81

A 45 y.o man describes successful abstinence from alcohol for the past six months following inpatient detoxification. During his admission, he was prescribed an ‘anti-craving’ medication. He takes this medication three times a day and would like you to continue the prescription as he finds it very helpful. It is safe in combination with alcohol and he has experienced no side effects. Which medication is he describing?

Answer 81

Acamprosate - effective in preventing alcohol relapse in combination with psychological support following detoxification in alcohol dependence syndrome
It has a minimal side effect and risk profile and is safe in combination with alcohol

Question 82

A 38 y.o. man presents with opioid dependence syndrome presents to clinic. He currently takes 30ml of methadone daily. He wishes to come off of his methadone as he finds it too sedating and is finding the stigma of being on methadone challenging. He reports friends have successfully come off methadone after stitching to a ‘tablet that goes under your tongue’ and wishes to try this. Which medication is the patient describing?

Answer 82

Buprenorphine - this is a mixed opioid agonist/antagonist. It is typically given as a sublingual tablet and provides an alternative opiate replacement therapy to methadone
Patient’s often describe beprenorphine as less sedating

Question 83

what is something that prescribers should keep in mind when administering methadone?

Answer 83

prescribers must be aware that because of the opioid antagonist properties of methadone, it can render regularly prescribed analgesia, such as co-codamol, ineffective

Question 84

What is chlordiazepoxide and when is it used?

Answer 84

it is a benzodiazepine often used as part of a reducing regime during alcohol dependence

Question 85

On examination, the patient appears unkempt. When asked how they are, the patient replies ‘I’m fine, like sweet wine, the pleasure is mine’.

What best describes this behaviour?

Answer 85

clang associations

Question 86

What is cluster B personality and what are the types?

Answer 86

Cluster B traits include being dramatic and overly emotional, unpredictable thinking, and/or behaviour associated with the above. Cluster B includes antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder.

Question 87

What is Korsakoff’s syndrome?

Answer 87

a complication of Wernicke’s encephalopathy. It’s features include: anterograde amnesia, retrograde amnesia, and confabulation

Question 88

What is the classic triad of Wernicke’s encephalopathy?

Answer 88

ophthalmoplegia (often a lateral rectus palsy and/or horizontal nystagmus), confusion and ataxia (though any cerebellar signs can be present)

Question 89

What is akathisia?

Answer 89

a sense of inner restlessness and inability to keep still - typical with a long history of anti-psychotic use

Question 90

What are the metabolic side effects of antipsychotics?

Answer 90

dysglycaemia, dyslipidaemia, and diabetes

Question 91

What is the first-line treatment for children and young people with anorexia nervosa?

Answer 91

anorexia focused family therapy

Question 92

A 30 y.o. man with bipolar disorder is taking lithium. He was recently started on thiazide diuretics for mild hypertension. He is now confused with ataxia, blurred vision and a coarse tremor. What is the single most likely diagnosis?
Alcohol withdrawal
Lithium toxicity
Opioid withdrawal
Renal failure
Thyrotoxicosis

Answer 92

Lithium toxicity

Question 93

A 50 y.o. man with a history of schizophrenia is started on haloperidol. A month later he is noted to be stiff and complains of tremor in both arms. What is the single most likely diagnosis?
Cushing’s syndrome
Extra-pyramidal side-effects
Neuroleptic malignant syndrome
Parkinson’s disease
Tardive dyskinesia

Answer 93

Tardive dyskinesia

Question 94

A 40 y.o. female complains of dry mouth, blurry vision, and constipation. On examination she had dilated pupils. She was started on amitriptyline for major depression. What is the single most likely diagnosis?
Anticholinergic side effects
Extra-pyramidal side effects
Neuroleptic Malignant syndrome
Noradrenergic side-effect
Serotonin syndrome

Answer 94

Anticholinergic side effects

Question 95

A 30 y.o. man with history of psychosis presents to casualty saying he has a dislocated shoulder. On examination, the shoulder is found not to be dislocated. The patient insists it is dislocated and will not accept reassurance from the doctors. What is the single most likely diagnosis?
Delusional disorder
Dissociative disorder
Hypochondriacal disorder
Panic disorder
Somatisation

Answer 95

Delusional disorder
Hypochondriacs can entertain the possibility that the feared disease is not present. In contrast, people with somatic-type delusional disorder are completely convinced of the physical basis of their complaints.

Question 96

A 28 y.o. woman lost her job three months ago. She attends her GP complaining of difficulty in sleeping,. She feels tired, has a poor appetite and has lost some weight. She feels worthless. She has thought of committing suicide and says that her husband would not miss her if she were dead. What is the single most appropriate treatment option?
Fluoxetine
Lithium
Mirtazapine
Moclobemide
Zopiclone

Answer 96

Fluoxetine

Question 97

A 22 y.o. single woman gave birth to her first child three days ago. Since the birth she has been unable to sleep and is reluctant to hold her baby or feed her. She is very tearful and cries for no reason. She denies thoughts of harming the baby. What is the single most appropriate treatment option?
Diazepam
Fluoxetine
Monitor
Risperidone
Zopiclone

Answer 97

Monitor

Question 98

A 64 y.o. woman has a three year history of increasing confusion, loss of mobility and tremor. She has recently developed frequent visual hallucinations and tends to cry out for no reason, particularly at night. There is no evidence of an acute medical cause for her confusion. On examination she is alert but disorientated and quite agitated. She has a coarse resting tremor, increased tone in her limbs and normal reflexes. What is the single most appropriate treatment option?
Fluoxetine
Procyclidine
Risperidone
Rivastigmine
Zopiclone

Answer 98

Rivastigmine

Question 99

A mother is worried about her 25 y.o. son. He seems to jump from one topic to another, make up words, laugh at inappropriate things and talk to someone imaginary. He has blacked out his windows and complains that someone else is controlling his thoughts. What is the single most likely diagnosis?
Alcohol intoxication
Cannabis use
Depression with psychotic symptoms
Hypomania
Paranoid schizophrenia

Answer 99

Paranoid schizophrenia

Question 100

A 40 y.o. man presents to his GP with headaches, insomnia and weight gain. He is slow and sluggish when he speaks. He describes a loss of interest in everything, a feeling of worthlessness and often cries alone. What is the single most likely diagnosis?
Adjustment disorder
Depression
Generalised anxiety disorder
Hyperthyroidism
Schizophrenia

Answer 100

Depression

Question 101

Which eye condition is associated with Charles-Bonnet syndrome?

Answer 101

Age-related macular degeneration and cataracts
Patients tend to have visual hallucinations, especially when it is dark, due to the inability to differentiate contrast sensitivity.

Question 102

A 54 y.o. man attends his GP. He was started on fluoxetine eight weeks ago for depression and is now requesting to stop his medication as he feels so well. How long should his medication be continued for before he stop it completely?

Answer 102

it should be continued for at least 6 months after signs of remission
this greatly reduces the risk of relapse and patients should be reassured that antidepressants are not addictive

Question 103

Bulimia nervosa can have ECG signs of first-degree heart block, tall P waves and flattened T waves. It can also have metabolic alkalosis and low chloride. Why is this?

Answer 103

The patient’s ECG shows features of hypokalaemia which is a likely cause of palpitations
The low chloride suggest the cause of the metabolic alkalosis is loss of hydrochloric acid from the stomach (through vomiting). Severe vomiting would also account for the hypokalaemia shown on ECG

Question 104

What is the mechanism of action of venlafaxine?

Answer 104

serotonin and noradrenaline reuptake inhibitor

Question 105

With alcohol withdrawal, what is the timing for having the following presentations after the last drink?
symptoms
seizures
delirium tremens

Answer 105

symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours

Question 106

A 34 y.o. lady has presented to her GP for review of her medication. She was diagnosed with bipolar disorder 8 months previously and has been taking olanzapine 10mg once daily and lithium carbonate 600mg twice daily. She has noticed that her psychological symptoms have improved overall, however she reports feeling more tired in the past month. She also reports reduced appetite and with bouts of constipation. Given her presentation, what is the most likely explanation for her symptoms?

Answer 106

hypothyroidism due to lithium toxicity
it usually manifests between 6-18 months after initiation of treatment

Question 107

A 54 y.o. man with no past medical history is being started on tranylcypromine (a monoamine oxidase inhibitor) for depression. Which foods should he be advised to avoid?

Answer 107

cheese
when tyramine containing food (eg cheese) are taken alongside monoamine oxidase inhibitors a hypertensive crisis can occur

Question 108

A 45 y.o. man with schizophrenia taking chlorpromazine develops an oculogyric crisis. What side-effect of antipsychotic medication is this an example of?

Answer 108

Acute dystonia

Question 109

What does taking an SSRI alongside an NSAID increase the risk of? What should be prescribed alongside these?

Answer 109

increases the risk of GI bleeding, therefore a PPI should be prescribed

Question 110

What is a side effect of lorazepam relating to memory?

Answer 110

One of the side effects of this drug is that this can cause anterograde amnesia, where memory recall and the creation of new memories is significantly impaired.

Question 111

A wife cannot cope with her husband’s moods. She says he is very labile. He goes from being full of energy and happy one day to being so pessimistic about everything the next day. What is the single most likely diagnosis?
bipolar affective disorder
borderline personality disorder
dependent personality disorder
dysthymia
generalised anxiety disorder

Answer 111

borderline personality disorder

Question 112

A 56 year old woman says that she hears her recently deceased husband in and around the house. What is the single most appropriate treatment option?
anti-depressive medication
anti-psychotic therapy
anxiolytic medication
behavioural therapy
bereavement counselling

Answer 112

bereavement counselling

Question 113

A 19 year old female university student undertakes hand washing up to 20 times in one day; this is getting in the way of her work. What is the single most appropriate initial treatment option?
benzodiazepines
clomipramine
CBT
group therapy
sertraline

Answer 113

CBT

Question 114

A 60 y.o. homeless man who smells of alcohol is admitted to a medical ward after a fall. He is confused and says he thinks that the nurses are going to kill him. What is the single most appropriate course of action?
arrange for urgent CT head scan
detain under section 5(2) of the MHA
prescribe chlordiazepoxide
prescribe pabrinex
undertake physical examination

Answer 114

undertake a physical examination

Question 115

A 24 y.o. man says that he can hear a voice talking to him and it is controlling his thoughts. What is the single most appropriate treatment option?
anti-depressant medication
anti-psychotic medication
behavioural therapy
bereavement counselling
electro-convulsive therapy

Answer 115

anti-psychotic medication

Question 116

A 40 y.o. woman is scared of flying to the degree she will not fly at all. What is the single most appropriate option?
anti-depressant medication
benzodiazepine medication
cognitive-behavioural therapy
group therapy
hypnotherapy

Answer 116

cognitive behavioural therapy

Question 117

A mother brings her child to you in outpatients with chronic constipation. On physical exam you notice unusual bruising on both arms. What is the single most appropriate initial management option?
arrange an abo X-ray
inform child safeguarding team
inform the police
prescribe laxatives
refer her child to a child psychiatrist

Answer 117

inform child safeguarding team

Question 118

A 25 y.o. woman with a history of depression and self harm arrives at ED saying she has ingested an unknown amount of an unknown drug. What is the single most appropriate management option?
begin N-acetyl cysteine therapy
contact GP
complete a physical health assessment
refer to a psychiatrist
refer to general medical team

Answer 118

complete a physical health assessment

Question 119

A 30 y.o. man recently started on olanzapine presents with dizziness and irritability. In ED the patient behaves aggressively and abuses the nursing staff. On examination you find him to be febrile, and mild neck rigidity is present. What is the single most appropriate management option?
admit to general medical ward
increase his dose of olanzapine
prescribe lorazepam
refer to psychiatrist
resuscitate in the department

Answer 119

resuscitate in the department

Question 120

A 26 y.o. woman who used to be an IV drug user had completely stopped taking drugs. She comes to you saying that her boyfriend is now forcing her to take drugs again. She has noticeable bruising on her arms and legs. What is the single most appropriate management option?
discuss with adult safeguarding team
inform the police
prescribe naloxone
prescribe naltrexone
refer to addiction services

Answer 120

discuss with adult safeguarding team

Question 121

A 25 y.o. woman finds it difficult to leave her home. She becomes very agitated in supermarkets and describes palpitations and difficulty breathing when in crowds. What is the single most likely diagnosis?
agoraphobia
bipolar affective disorder
generalised anxiety disorder
PTSD
social phobia

Answer 121

agoraphobia

Question 122

A 40 y.o. man complains of low mood and fatigue. He has a poor appetite and has loss of libido. He wakes at 2am and is unable to return to sleep. He feels guilty about the death of his mother 2 years ago. What is the single most likely diagnosis?
bipolar affective disorder
depressive episode
generalised anxiety disorder
panic disorder
social phobia

Answer 122

depressive episode

Question 123

A 30 y.o. man is seen in dermatology outpatients with very sore hands. He has dry, cracked skin on all his fingers. He says he has to wash his hands at least 30 times a day and is unable to sleep if he has not done so. What is the single most likely diagnosis?
delusional disorder
generalised anxiety disorder
hypochondriacal disorder
obsessive compulsive disorder
PTSD

Answer 123

obsessive compulsive disorder

Question 124

A 20 y.o. woman attends A&E complaining of sudden breathlessness and anxiousness. She describes palpitations and pins and needles in her hands, feet and lips. Her ECG shows sinus tachycardia and oxygen saturation is normal. What is the most likely diagnosis?
bipolar affective disorder
depression
hypochondriacal disorder
panic attack
social phobia

Answer 124

panic attack

Question 125

A 36 y.o. train driver is on sick leave after an incident in which a child ran onto the tracks. He is unable to go near railways and takes excessively long routes to avoid them. He is troubled by flashbacks of the accident, which frequently disturbs his sleep. What is the single most likely diagnosis?
generalised anxiety disorder
hypochondriacal disorder
obsessive compulsive disorder
panic disorder
PTSD

Answer 125

PTSD

Question 126

A 76 y.o. man is agitated and euphoric. He claims to be helping the Prime Minister and the President of the United States with economic policy. He lives in sheltered accommodation. There are no signs or symptoms of physical illness. What is the single most likely diagnosis?
alcohol withdrawal
delirium
dementia
mania
personality disorder

Answer 126

mania

Question 127

A 20 y.o. man complains that all his movements are being watched. Sometimes he feels as though his actions are being controlled by his radio. At other time he is aware of voices describing what he is doing. What is the single most likely diagnosis?
delirium
Korsakoff’s psychosis
mania
psychotic depression
schizophrenia

Answer 127

schizophrenia

Question 128

A 50 y.o. man presents in outpatients complaining of being pursued by the police for a crime he denies committing. He has poor concentration and impaired short term memory. He admits to drinking large amounts of alcohol. What is the single most likely diagnosis?
Alzheimer’s
delusional disorder
hypomania
Korsakoff’s psychosis
Wernicke’s encephalopathy

Answer 128

Korsakoff’s psychosis

Question 129

A 65 y.o. woman says that she died three moths ago and is very distressed that nobody has buried her. When she is outdoors she hears people say that she smells and needs to be punished. What is the single most likely diagnosis?
Alzheimer’s
conversion disorder
Cotard’s syndrome
Korsakoff’s psychosis
schizophrenia

Answer 129

Cotards syndrome

Question 130

A 49 y.o. woman is recovering from a hysterectomy two days ago. She becomes agitated and complains of seeing animals and children walking around the wards. Her husband reports she drinks at least a bottle of wine per day. what is the single most appropriate treatment?
ascorbic acid
diazepam
disulfiram
haloperidol
thiamine

Answer 130

thiamine

Question 131

A 30 y.o. man slowly develops severe depression over a number of months. He stops his hobbies and interests, his social contact diminishes and his mood becomes very low. He visits a psychiatrist for the first time because he is becoming increasingly distressed with disturbed sleep patterns and no appetite. He feels his future is hopeless. What is the single most appropriate treatment option?
amitriptyline
citalopram
mirtazapine
olanzapine
venlafaxine

Answer 131

citalopram

Question 132

A 55 y.o. woman has episodes of mania associated with frequent depressive episodes. What is the single most appropriate treatment option?
carbamazepine
chlorpromazine
clozapine
lorazepam
sodium valproate

Answer 132

sodium valproate - used to treat bipolar disorder

Question 133

An 18 y.o. woman with no physical health problems is waiting for her A-level exam results. They will arrive by post today and she is suffering from acute anxiety due to the importance of these results for her future. Her mother consults her GP. What is the single most appropriate treatment option?
CBT
lorazepam
practicing mindfulness techniques
propanolol
temazepam

Answer 133

practicing mindfulness techniques

Question 134

A 87 y.o. woman moved in to a residential care home two weeks ago. She has a diagnosis of Alzheimer’s disease and was started on donezepil six months ago. She has become agitated and wants to return to her own home. What is the single most appropriate option?
admit to hospital under the mental capacity act
admit to hospital under the mental health act
investigate for an organic cause for this presentation
organise an urgent CT head head scan
prescribe risperidone

Answer 134

investigate for an organic cause for this presentation

Question 135

A 32 y.o. man with history of depression and a previous attempt to end his life by hanging comes to ED. He says he is relapsing, feels hopeless, and cannot keep himself safe at home anymore. He says he wants help but cannot face going home. He has been taking his medication as prescribed. He asks to be admitted to hospital. What is the single most appropriate treatment option?
admit as a voluntary patient
detain under section 2
detain under section 3
detain under section 5(2)
refer to intensive community support team

Answer 135

admit as a voluntary patient

Question 136

A 90 y.o. man is admitted to a nursing home. He has a diagnosis of Alzheimer’s disease but is on no medication. He becomes aggressive and starts urinating in waste bins. What is the single most appropriate treatment option?
admit for psychiatric assessment
exclude delirium
organise a CT head scan
prescribe donepezil
prescribe olanzapine

Answer 136

exclude delirium

Question 137

A 44 y.o. woman with a history of agoraphobia presents with an acute GI bleed. After recovery she is commenced on an antidepressant to help with her mental health disorder. What is the most likely drug that the psychiatrists will recommend is avoided?
clomipramine
fluoxetine
mirtazapine
risperidone
venlafaxine

Answer 137

fluoxetine

Question 138

A 42 y.o. man is brought to hospital by the police. they found him trying to stop traffic on the motorway saying the Lord was making him do it. The police reports thinks that he has a mental illness. He has not been seen by a doctor. What is the single most likely section the patient is detained under?
section 2
section 5(2)
section 62
section 135
section 136

Answer 138

section 136

Question 139

A 61 y.o. man with a history of a traumatic head injury in a motorcycle accident presents with memory problems. He forgets to take his medication, is disorientated in time and is incontinent of urine. He walks as if he is intoxicated and needs a zimmer frame to mobilise safely. What is the single most likely diagnosis?
Alzheimer’s disease
fronto-temporal dementia
lewy body dementia
neurosyphilis
normal pressure hydrocephalus

Answer 139

normal pressure hydrocephalus

Question 140

A 31 y.o. man has been diagnosed as suffering from schizophrenia. He is known to have a history of heavy recreational drug use starting in his teenage years. His psychiatrist tells him that the substance he uses may have contributed to him developing disorder. Which of the following drugs is the psychiatrist most likely to be referring to?
alcohol
cannabis
cocaine
heroin
LSD

Answer 140

cannabis

Question 141

A 39 y.o. woman is recovering from a hysterectomy three days ago. She dose not drink alcohol at all and dose not use recreational drugs. At night she becomes agitated and complains of seeing animals and children walking around the wards. What is the single most likely diagnosis?
delirium
dissociative disorder
hypomania
Korsakoff’s psychosis
schizophrenia

Answer 141

delirium

Question 142

A 25 y.o. man is admitted to hospital after developing psychotic symptoms, including some which his psychiatrist describes as “first rank”. Which of the following is the patient most likely to be suffering from as a first rank symptom?
2nd person auditory hallucinations
3rd person auditory hallucinations
blunting of affect
flight of ideas
persecutory delusions

Answer 142

3rd person auditory hallucinations

Question 143

A 19 y.o. Afro-Caribbean man, who has emigrated to London from Jamaica, develops psychotic symptoms. His father had been diagnosed with schizophrenia. Which statement best describes this mans risk of developing schizophrenia?
about 50%
higher than general population
lower than general population
same as general population
unaffected when compared to general population unless he also smokes cannabis

Answer 143

higher than general population

Question 144

A 78 year old man with a history of chronic schizophrenia presents to the ED with a three week history of worsening auditory hallucinations which have been accompanied by frightening visual hallucinations over the past three days. He has developed urinary incontinence over the past week. What is the most likely cause of his current symptoms?
acute polymorphic psychosis
delirium
delirium tremens
dementia
schizophrenia

Answer 144

delirium

Question 145

A man presents with persecutory delusions and third person auditory hallucinations. He is diagnosed with schizophrenia. He has no previous psychiatric history and no family history of mental health problems. From the information above, in what age range is this patient most likely to be?
18-30 years
30-40 years
40-50 years
50-60 years
over 60 years

Answer 145

18-30 years

Question 146

A diagram relates to a psychological model used to treat mental health disorders. Three domains have been replaced by letters A, B and C. These domains are related to negative automatic thoughts. What do these letters represent?
conversion, dissociative and somatoform
id, ego, superego
physical sensations, emotions, behaviours
repression, regression and reaction formation
transference, counter-transference and sublimation

Answer 146

physical sensations, emotions and behaviours

Question 147

Which of the following treatments is ECT licensed for?
alcohol dependence
borderline personality disorder
life-threatening depression
panic disorder
social anxiety

Answer 147

life-threatening depression

Question 148

What is the typical representation of deterioration of a patient with vascular dementia?

Answer 148

stepwise deterioration

Question 149

A 78 y.o. man presents with symptoms of hypomania and wight loss. He has no previous psychiatric history of note. He has smoked 20 cigarettes per day since leaving school. On cognitive testing he takes over 5 mins attempting to complete the visuospatial part. Where is the most likely site of any lesion causing this performance?
anterior temporal lobe
frontal lobe
medial temporal lobe
occipital lobe
parietal lobe

Answer 149

frontal lobe

Question 150

A 23 y.o. man with schizophrenia is admitted after a relapse. A formulation box plot is constructed for him which is the bio-psycho-social model. According to the table, what type of aetiological factor is his job loss?
biological precipitating
biological predisposing
psychological perpetuating
social perpetuating
social precipitating

Answer 150

social precipitating

Question 151

A 42 y.o. man with bipolar affective disorder has a relapse after stopping his prescribed medication. He is depressed and has a plan to end his life by suicide. The team want to admit him to hospital in order to maintain his safety and start treatment with Lithium. The gentleman as he sees no point in living as a result of his severe depression.
Section 1 of MHA
Section 12 of MHA
Section 17A supervised community treatment order (CTO)
Section 2 of MHA
Section 3 of MHA
Section 4 of MHS
Section 5(2) of MHA
Section 5(4) of MHA
Section 136 of MHA

Answer 151

Section 3

Question 152

A 23 y.o. woman is brought to ED by her parents. they are worries as she has come home from university and told them she is hearing a voice telling her to hurt her 12 y.o. brother. She is struggling to ignore the voice and the family are worries she might act on the instructions. She has never been unwell in the past and there is no family history of any physical or mental illness. This lady refuses further support from community services and refuses to be admitted to hospital.
Section 1 of MHA
Section 12 of MHA
Section 17A supervised community treatment order (CTO)
Section 2 of MHA
Section 3 of MHA
Section 4 of MHS
Section 5(2) of MHA
Section 5(4) of MHA
Section 136 of MHA

Answer 152

Section 2

Question 153

A 20 y.o. man is found by the police standing on a bridge. When the police approach he says he is going to jump off as he wants to die. He tells the police his life is not worth living and he can see no future for himself. The police ring the local crisis team for advice and are told to bring him to a safe place for an assessment.
Section 1 of MHA
Section 12 of MHA
Section 17A supervised community treatment order (CTO)
Section 2 of MHA
Section 3 of MHA
Section 4 of MHS
Section 5(2) of MHA
Section 5(4) of MHA
Section 136 of MHA

Answer 153

Section 136 of MHA

Question 154

A 79 y.o. man presents to the ED because he cannot live in his house anymore. He says it has been bugged by the neighbours and they are piping music into his front room to annoy him. He can hear them laughing when he gets upset by this. He says the police have not helped and if you don’t help he will go round to the neighbours with a kitchen knife. On examination there is no evidence of any physical disorder, and he has no previous mental health problems.
Section 1 of MHA
Section 12 of MHA
Section 17A supervised community treatment order (CTO)
Section 2 of MHA
Section 3 of MHA
Section 4 of MHS
Section 5(2) of MHA
Section 5(4) of MHA
Section 136 of MHA

Answer 154

Section 2 of MHA

Question 155

A 35 y.o. woman who took a deliberate overdose of paracetamol 3 days ago is on MAU. She requires further treatment as her liver has been damaged. She tells you she wants to leave the hospital as she need to buy more tablets to end her life. You feel she needs further assessment by a psychiatrist but they cannot attend immediately.
Section 1 of MHA
Section 12 of MHA
Section 17A supervised community treatment order (CTO)
Section 2 of MHA
Section 3 of MHA
Section 4 of MHS
Section 5(2) of MHA
Section 5(4) of MHA
Section 136 of MHA

Answer 155

Section 5(2)

Question 156

A 33 y.o. electrician is brought to his GP by his wife. He has a four week history of sleep disturbance with initial insomnia and early waking, irritability and racing thoughts. He talks rapidly and says he has remortgaged his house as he is planning to buy a private passenger jet. He has spent £12,000 in organising this. He has no previous psychiatric history.
alcohol dependence syndrome
anorexia nervosa
generalised anxiety disorder
bipolar affective disorder
borderline personality disorder
bulimia nervosa
dementia
depressive episode
manic episode
paranoid schizophrenia
post traumatic stress disorder

Answer 156

manic episode

Question 157

A 59 y.o. woman complains of poor concentration over the last few months. She says she feels tired all the time. She feels low and hopeless. She has made a will recently as she is convinced she will die in the next few weeks.
alcohol dependence syndrome
anorexia nervosa
generalised anxiety disorder
bipolar affective disorder
borderline personality disorder
bulimia nervosa
dementia
depressive episode
manic episode
paranoid schizophrenia
post traumatic stress disorder

Answer 157

depressive episode

Question 158

A 21 y.o. physiotherapy student sees her GP as she is worried about her weight. She enjoys running and has completed 4 marathons this year. She is concerned that she has been gaining weight despite limiting her calorie intake to under 1200 calories a day. Her height is 158cm and her weight is 43kg.
alcohol dependence syndrome
anorexia nervosa
generalised anxiety disorder
bipolar affective disorder
borderline personality disorder
bulimia nervosa
dementia
depressive episode
manic episode
paranoid schizophrenia
post traumatic stress disorder

Answer 158

anorexia nervosa

Question 159

a 45 y.o. man is under the care of the assertive outreach team. He has been treated for 20 years for an illness which has caused him to lose contact with all friends from his childhood. He is able to live independently but cannot work due to his mental disorder. he takes an injection medication once a month to manage his symptoms of thought disorder and auditory hallucinations.
alcohol dependence syndrome
anorexia nervosa
generalised anxiety disorder
bipolar affective disorder
borderline personality disorder
bulimia nervosa
dementia
depressive episode
manic episode
paranoid schizophrenia
post traumatic stress disorder

Answer 159

paranoid schizophrenia

Question 160

A 28 y.o. man is seen in outpatients. He was a passenger in a car crash 3 months ago. He feels ‘cut off’ from his family and has lost pleasure in spending time with them. He has vivd dreams of the car crash and gets flashbacks of the experience if he sits in a passenger seat on any car journey.
alcohol dependence syndrome
anorexia nervosa
generalised anxiety disorder
bipolar affective disorder
borderline personality disorder
bulimia nervosa
dementia
depressive episode
manic episode
paranoid schizophrenia
post traumatic stress disorder

Answer 160

post traumatic stress disorder

Question 161

A 25 y.o. woman is detained by the police. In custody she appears euphoric but later becomes quiet and difficult to rouse. On examination, the custody suite nurse finds she has a heart rate of 50 beats per minute, a respiratory rate of 4 breaths per minute and blue lips.
Alcohol
Amphetamine
Barbiturates
Cannabis
Cocaine
Ecstasy
Ketamine
Mephedrone
Methadone
Solvents

Answer 161

Methadone

Question 162

A 23 y.o. man tells his friends that he thinks that everyone can tell which drug he has been taking. He says he is feeling really nervous and anxious about this but his friends note that he has been ravenously eating several bags of crisps and a pizza whilst discussing these fears.
Alcohol
Amphetamine
Barbiturates
Cannabis
Cocaine
Ecstasy
Ketamine
Mephedrone
Methadone
Solvents

Answer 162

cannabis

Question 163

A 25 y.o. man is arrested after running down a dual carriageway. He resists arrest as he reports that he is being chased by large dark aliens which he can see. They hiss at him and tell him they are going to kill him. He believes the aliens are in league with the army who are hunting him and want to kill him. He tells his story clearly and rationally but is extremely agitated and restless.
Alcohol
Amphetamine
Barbiturates
Cannabis
Cocaine
Ecstasy
Ketamine
Mephedrone
Methadone
Solvents

Answer 163

amphetamine

Question 164

A 24 y.o. man is arrested for driving under the influence of drugs. He says that he can see sounds, taste colours and hear the smells. He can see flocks of coloured butterflies in his cell. He has slurred speech and tells the custody officer that he looks all wavy and weird. After a few hours his symptoms dissipate but he starts to complain of lower abdominal pains.
Alcohol
Amphetamine
Barbiturates
Cannabis
Cocaine
Ecstasy
Ketamine
Mephedrone
Methadone
Solvents

Answer 164

Ketamine

Question 165

A 17 y.o. is arrested at a festival after she threw her arms round a policeman and knocked him over. In custody she remains bright and energetic, and tells the custody officer he is beautiful and has lovely eyes.
Alcohol
Amphetamine
Barbiturates
Cannabis
Cocaine
Ecstasy
Ketamine
Mephedrone
Methadone
Solvents

Answer 165

ecstasy

Question 166

A 25 y.o. woman who is moderately depressed without suicidal ideation. She wants help to improve her mood but does not want to take antidepressant medication.
Benzodiazepine meds
Clozapine treatment
Cognitive behavioural therapy
Depot anti-psychotic
Electroconvulsive therapy
In-patient admission
Psychoanalytical psychotherapy
Referral to occupational therapist
Visits from a community psychiatric nurse

Answer 166

Cognitive behavioural therapy

Question 167

A 32 y.o. man with hallucinations and delusions is unable to work because of his symptoms. He struggles to take tablets on a regular basis but has responded well to treatment with haloperidol in the past. He would like to try a treatment that could reduce his symptoms and enable him to work.
Benzodiazepine meds
Clozapine treatment
Cognitive behavioural therapy
Depot anti-psychotic
Electroconvulsive therapy
In-patient admission
Psychoanalytical psychotherapy
Referral to occupational therapist
Visits from a community psychiatric nurse

Answer 167

Depot anti-psychotic

Question 168

A 45 y.o. woman has become increasingly low and withdrawn over the past two months. She has suffered with depression in the past and attempted to end her life by suicide three years ago. She feels hopeless and has told her friends that she has bought several packets of ibuprofen which she wants to take to end her life.
Benzodiazepine meds
Clozapine treatment
Cognitive behavioural therapy
Depot anti-psychotic
Electroconvulsive therapy
In-patient admission
Psychoanalytical psychotherapy
Referral to occupational therapist
Visits from a community psychiatric nurse

Answer 168

In-patient admission

Question 169

A 75 y.o. man with recurrent depressive disorder is admitted to hospital under section 3 of the Mental Health Act. He believes that his insides have ‘died’ and so has stopped eating and drinking. He is refusing all tablet medication. his kidney function is so poor he needs IV fluids. His life is at risk without urgent treatment.
Benzodiazepine meds
Clozapine treatment
Cognitive behavioural therapy
Depot anti-psychotic
Electroconvulsive therapy
In-patient admission
Psychoanalytical psychotherapy
Referral to occupational therapist
Visits from a community psychiatric nurse

Answer 169

Electroconvulsive therapy - he is catatonic depressive

Question 170

While planning the discharge from hospital of a 41 y.o. man with chronic schizophrenia, the hostel where he normally lives is concerned about possible risks when he is preparing meals when he is on his own, especially around fire safety.
Benzodiazepine meds
Clozapine treatment
Cognitive behavioural therapy
Depot anti-psychotic
Electroconvulsive therapy
In-patient admission
Psychoanalytical psychotherapy
Referral to occupational therapist
Visits from a community psychiatric nurse

Answer 170

Referral to occupational therapist