Practice questions Flashcards
Mrs P, a 49-year-old woman, has been brought to her GP by her husband who is worried about her drinking. In the consultation she admits that over the last 3 months she has dropped many of her usual hobbies due to drinking, feels she needs to drink more than she used to to get the same effect and feels strong compulsions to drink, even after some accidents that have happened while intoxicated. How likely is it that she has alcohol dependence?
Diagnostic threshold met for alcohol dependence
CAGE Screening tool to detect problem drinking and alcoholism.
Details on other tests e.g. AUDIT
criteria used to assess if someone has alcohol dependence:
Cravings/compulsions to take
Difficulty controlling use
Primacy
Increased tolerance
Physiological withdrawal on reduction/cessation
Persistence despite harmful consequences
What is the recommended maximum units of alcohol men and women can drink in one week?
14 units per week
Which of the following alcohol screening tests is the most accurate when screening pregnant woman?
TWEAK
Which of the following is a classic physical sign of alcohol misuse you may find on examination?
Asterixis
To calculate the number of units in a bottle, you need to multiply the number of millilitres by the ABV and then divide this by 1000 [INSERT EQUATION].
A bottle of wine (alcohol percentage = 12%) contains 750ml. How many units are found in the bottle?
9 units
To calculate the number of units in a drink multiply the number of millilitres by the ABV and divide by 1,000.
one bottle of wine = 750 * 12 / 1000 = 9 units
Consumption (units per week): Drinking more than 14 units a week, but less than 35 units a week for women. Drinking more than 14 units a week, but less than 50 units for men.
Drag and drop the symptoms suggestive of acute alcohol withdrawal most noted within certain time frames from last drink
symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety, nausea, vomiting
peak incidence of seizures at 36 hours
peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia, sleeplessness, autonomic over-activity
•Mrs P and her husband would like to know what drug treatments are available for alcohol addiction. Match the drugs and their actions.
•13 months later, Mrs P presents again with her husband. She has had a rough couple of months following being fired from her job and admits to drinking again and has stopped taking her medication for alcohol cessation . On examination you notice she has some physical findings such as nystagmus and ataxia, and during the history you notice she seems quite confused, with her husband adding she has become noticeably more confused in the last few weeks. According to these findings, what do you think is the most pressing management to be organized immediately?
Urgent thiamine replacement
Foetal alcohol spectrum disorders, wernickes and korsokoffs, delirium tremens, cancers
Explain wernickes and Korsakoff syndrome
If those with comorbidities of depression or anxiety on withdrawal have symptoms, treat alcohol dependence first and review in 3-4 weeks. These symptoms can improve on treatment but if still persistent undertake an assessment of symptoms and consider referral (NICE)
•A young boy presents with their mother, who is concerned about some behaviours her son has been exhibiting in the last few months. She describes her son as taking a very long time to get ready for school as he is repetitively checking light switches and so has gotten in trouble at school due to being late repeatedly. Based on the most likely diagnosis, what is the most appropriate initial treatment?
Exposure and response trainning
•A young woman presents to her GP quite worried about the sensation of something in her throat. She also complains of tiredness as she is struggling to sleep, tremors, feels she can sweat profusely when stressed, having a poor appetite and feeling nauseous. She strikes you as quite anxious about these symptoms, especially as she has some exams coming up. What would be the next best step for this patient?
Reassure patient and advise some lifestyle changes
You are concerned about your sibling who is extremely fearful of attending the doctors, and often experiences panic attacks when at the doctors, resulting in them missing many of their review appointments for their long-term conditions and routine screening appointments despite their conditions being well controlled and there being no medical concerns. You suspect they might have developed a phobia to the doctors. Select from those shown below what psychological treatments could be offered to help those who suffer from phobic disorders
•A patient attends complaining of feeling very anxious all the time, and describes other symptoms such as tremor, palpitations and sweating profusely. What blood test should also be carried out before diagnosing GAD to exclude another important differential diagnosis?
TFTs
•A patient is diagnosed with obsessive compulsive disorder. They are known to be very inflexible in their work and their routine, which has caused some issues with their loved ones and colleagues. Which of the following is the 1st line treatment for mild obsessive compulsive disorder?
Exposure response prevention therapy
•A 13-year-old female presents with her parents due to concern regarding their recurrent panic attacks and nightmares that on questioning seem to be related to attending school, even after moving schools after being very badly bullied in her last school. When asked about the bullying she gets very tearful and refuses to talk about it. For the last few years, the parents have noticed she has become more withdrawn and doesn’t hang out with her old friends anymore. What is the most likely diagnosis?
PTSD
•Drag and drop the following options for GAD symptoms under the following subsections: Cognitive, somatic and behavioural
•Who can complete a Certificate of Incapacity form? Tick all that apply
•Which legal document is used in Scotland when assessing if an individual has capacity?
A.Adults with Incapacity (Scotland) Act 2000
•The power from which legal document is needed if you think a patients mobile phone may need to be confiscated as they are putting themselves or ward staff at risk, or it has a detrimental effect on their care?
Specific person
•Select which of the following are powers available to the Police
•Which act would be used to determine if an individual had diminished responsibility due to their mental health?
A.Criminal Justice and Licensing (Scotland) Act 2010
•Which of the following are the 5 necessary factors when assessing if a treatment order is necessary?
What are the typical hisotry of these dementias?
•Put in order these different types of dementia in order of how common they are – with 1 being most common to 4 being least common
- Alzheimers disease
- Vascular dementia
- Lewy body dementia
- Frontotemporal dementia
•A 68-year-old man presents to ED with his concerned daughter who found him wandering lost late at night trying to find the pub. She tells you that her dad has been a bit more confused in the last few months, has not been sleeping well, and has been tearful at times which she thinks could be in relation to the recent passing of her mum 10 months ago. When you ask him some questions, many of his replies are simply “I don’t know”. What is the most likely diagnosis?
Depression
•Which screening tool is preferred when formally assessing for memory loss in secondary care settings?
Montreal cognitive assessment (MOCA)
•You are the FY1 on call overnight and you are asked to come and review a 72-year-old lady on the surgical ward who recently underwent a hemiarthroplasty 4 days ago. The nurses tell you she has become quite aggravated and confused in the last couple of hours. Her NEWS score stayed at 0 during the day and had not been complaining of any discomfort or other symptoms. What is the best next step?
Do a septic screen
What are the examples of these drugs and their notable side effects?
•Which of the following tests would not be as useful in the investigation of a patient with suspected dementia?
Digoxin levels
•You are a rural GP and a patient recently diagnosed with mild dementia has attended to consult you about an unrelated complaint. You notice that they arrive driving their own car and you enquire about whether they have told the DVLA about their Alzheimer’s diagnosis as you suggested. They tell you that they need the car to get about and do their food shops so they haven’t. What should you do next?
A.Tell the patient that if he does not contact the DVLA himself you will have to report it
What are the description of behaviour and the disorders?
•A man presents complaining of poor mood and loneliness. On questioning, you find he has been withdrawing from friends and family as he is worried about not being liked enough or criticized. He feels like he has been this way all of his life, though just might be getting a bit worse. What is this a typical history of?
Avoidant personality disorder
•A young woman presents to A+E with fresh self harm wounds. She tells you she had had a fight with her girlfriend as she doesn’t believe she can trust her and knows she must be cheating on her. She felt overwhelmed, and as she has fallen out with most of her friends, she didn’t know what else to do. Which of the following disorders could be the most likely diagnosis?
Emotionally unstable personality disorder
•A mother presents worried about her son. He is 26 years old and from a young age hasn’t shown any interest in forming any social relationships, and has been found to be quite cold and secretive by others. He prefers to be alone and all of his hobbies are solitary, with his favourite hobby being fantasy gaming and books. She notes he has always had a “wild sense of imagination”. What could be the underlying diagnosis?
Schizoid personality disorder
•A man presents to their GP with odd beliefs dressed in unusual attire. He is well known locally for his wild beliefs despite being quite reserved and not wanting to interact with others, and when caught up in conversations often talks to himself or displays peculiar speech mannerisms. They tell you that they feel very anxious in social settings due to often interpreting social interactions as odd or unusual. What disorder is this patient most likely to have?
Schizotypal personality disorder
•A man presents to his GP, and during the appointment acts quite inappropriately towards the GP by trying to make sexual advancements. When you try and shut down this behavior and end the consultation, he becomes annoyed at the lack of attention. You hear from the other GPs that have known him for most of his life that this is a common occurrence, even with individuals within the community. What could be the diagnosis for this patient?
Histrionic personality disorder
•A young man, who is well known to A+E and the police due to regular fights and getting into trouble all through their adolescence, has presented again to A+E after another fight. He again refuses to take any responsibility and shows no remorse for the innocent bystander he attacked. He has been caught multiple times trying to sneak away or lying about his actions. What is the most likely diagnosis?
Antisocial personality disorder
•Another consultant you work with has created a bit of a reputation on the ward. She is known to be very preoccupied with success and displays a high degree of self importance, and comes across as quite arrogant, cold and having a lack of empathy by your colleagues. What could be the likely cause?
Narcissistic personalitu disroder
•Which of the following parameters is not monitored annually after the patient is on an established dose of clozapine?
FBC
•Which of the following is not an important side effect of typical anti-psychotics such as chlorpromazine?
Weight gain
•What treatment is offered to those who have had an overdose on benzodiazepines?
Flumeazenil
•Select any of the following that can be used in the treatment of opioid dependence
What are examples and notable side effects of the dementia drugs?
•What is the mechanism of action of risperidone?
D2 receptor antagonist
•Which of the following is the most appropriate first line medication for the treatment of GAD?
Sertraline
•A patient is brought to A&E with a suspected overdose from a popular nightclub in the early hours of the morning. On examination, the patient is hyperthermic, hyperreflexic, have muscle rigidity and dilated pupils. What is the most likely substance that the patient has overdosed on?
Ectasy
•A patient in ED is suspected to have overdosed on TCAs. Which ECG changes would be seen? Tick all that apply
