Psych

Question 1

Treatment for acute dystonia

Answer 1

Procyclidine

Question 2

Aggressive and needs rapid tranquilisation

Answer 2

Haloperidol

Question 3

Moderate depression in young adult

Answer 3

Citalopram (sertraline 1st line)

Question 4

Women with mild depression management

Answer 4

CBT

Question 5

kid’s twin brother is most likely to have the same condition which is what

Answer 5

ADHD

Question 6

21 yo depressed with suicidal ideation. how do you manage?

Answer 6

SSRI + 1 week f/u

or admit

Question 7

Woman’s husband died 7 months ago. She recently started hearing the voice of husband. What is this

Answer 7

Abnormal grief reaction

Question 8

Alcoholic has cellulitis, given chlordiazepoxide and abx.

What else do you give?

Answer 8

Oral vitabin B1
Pabrinex - is an injection that contains vitamins B and C (thiamine, riboflavin, pyridoxine, nicotinamide and ascorbic acid)
B12

Chlordiazepoxide, trade name Librium among others, is a sedative and hypnotic medication of the benzodiazepine class; it is used to treat anxiety, insomnia and withdrawal symptoms from alcohol and/or drug abuse

Question 9

Old man, ex accountant, MMSE 28/30, somewhat forgetful, needs support from wife

Answer 9

Mild cognitive impairment

Question 10

Woman with LD in care home with change in behaviour after carer left. What is going on?

Answer 10

Challenging behaviour or depressive episode

Question 11

Refeeding syndrome - what’s the most important thing to check for? (pt had muscle spasm, abdo pain)

Answer 11

Calcium - because of the muscle spasms

otherwise hypophosphatemia is worse

Question 12

Drug for depression in MI patient?

Answer 12

Sertroline

Question 13

Old age boxer becomes aggressive on ward. What do?

Answer 13

Try to calm him down with verbal de-escalation, make him tea, debrief with nurses, start IV abx

Question 14

Aggressive pt - deescalation failed. What do?

Answer 14

Lorazepam + haloperidol

antipsychotic + benzo

Question 15

SE of clozapine

Answer 15

Neutropenia/ agranulocytosis

Question 16

Widow has 6 months of low mood, low energy, anhedonia, forgetfullness, lacking concentration. What is this?

A Severe depression with psychosis
B Severe depression without psychosis
C Adjustment disorder with depression
D Alzheimers

Answer 16

Severe depression without psychosis

Question 17

Guy on haloperidol gets muscle problems. What do?

Answer 17

Give IM procyclidine - acute dystonia

Question 18

Woman with sx of PTSD 6 months after traumatic experience. What’s the best management?

Answer 18

Eye Movement Desensitization and Reprocessing (EMDR)

Passmed says
Debriefing not reccomended
Watchful waiting for mild symptoms lasting less than 4 weeks
Trauma focused CBT or EMDR for severe

Question 19

Guy works in IT, doesn’t like sex or people. What kind of personality disorder is this?

Answer 19

Schizoid personality disorder

Question 20

Woman blushes in public???

Answer 20

Social phobia (buzzword??)

Question 21

Alcoholic wants to quit and wants something to help reduce cravings.

Answer 21

Acamprostate

Question 22

Guy with lewy body dementia is given a drug that makes his symptoms worse. What was the drug class?

Answer 22

Typical antipsychotics i.e. haloperidol

Question 23

Child with classic symptoms of ADHD, how do you manage?

Answer 23

1st line - family therapy

Question 24

What would an alcoholic need to have to be classified as being dependent?

Answer 24

Giving up pleasurable activities to drink more alcohol
Hallucinations
Drinking in different settings
Drinking in different modalties

Question 25

Lithium - what do you monitor?

Answer 25

Lithium, TFTs, U&E

Question 26

Woman fell over whilst gardening, comes in with paralysis of leg but no medical cause found. What is this?

Answer 26

Conversion disorder

Question 27

Patient on ward becomes aggressive, verbal de-escalation hasn't worked whats the tx?

Answer 27

Offer oral lorazepam first but if the questions suggests that verbal de-escalation aka also offering drugs didn't work then go for IM lorazepam and have a crash trolley ready as risk of respiratory depression

Question 28

``` Pt with dilated pupils, urinay retention, normal obs. What did he overdose with? A TCA/amytriptiline B Benzos C Opioids D SSRI ```

Answer 28

TCA/ Amytriptiline

Question 29

Alcoholic wants to quit but keeps failing. What do?

Answer 29

Inpatient Chlordiazepoxide + motivational interview?

Question 30

Suicide risk - whats the highest predictor of doing it again? A. Bad relationship with family B. Feeling hopeless about the future C. previous self harm

Answer 30

More likely B - hopelessness

Question 31

80 yo man new onset dementia, refuses MRI. You need someone to make the decision for him. Options A. talk to family with his permission B. independent mental health advocate

Answer 31

They said independent mental health advocate

Question 32

``` Woman on SSRI, wants to know what risk is there to the baby? A. stillbirth B pulmonary HTN of newborn C delayed labour D hypoglycemia at birht ```

Answer 32

B pulmonary HTN of newborn

Question 33

What is the only SSRI liscenced for under 18s?

Answer 33

Fluoxetine

Question 34

Woman wants to know risk to baby of getting schizophrenia, since baby's father has it?

Answer 34

1 in 10 - 20-25%

Question 35

Guy on meds for schizophrenia gets muscle rigidity, altered consciousness, high BP, tachycardia. What is the management?

Answer 35

``` Neuroleptic malignant syndrome ABCDE approach IV benzo if aggitated IV fluids Cooling if needed IV sodium bicarb if rhabdomyolisis Dantrolene and lorazepam to reduce rigidity ```

Question 36

What is high in anorexia nervosa?

Answer 36

Growth hormone

Question 37

Man with tx resistant schizophrenia on clozapine suddenly stops smoking. High levels of clozapine are in his blood. What is the most likely consequence of this?/

Answer 37

Seizures - dose dependent | Agranulocytosis is not dose dependent

Question 38

Alcoholic with PMH of delirium tremens wants home detox. What do you do?

Answer 38

Prescribe reducing dose of chlordiazepoxide

Question 39

``` GP scenario - old lady comes in with hx classical of Alzheimers. What do? A prescribe donazepil B refer to memory clinic C MRI head D reassure ```

Answer 39

B refer to memory clinic - NICE guidelines

Question 40

Most likely effect from cheese reaction due to MAO-I

Answer 40

``` Hypertensive crisis (interaction between MAO-I and thyiamine containing drugs- causes Noradrenaline NA release whcih causes tachycardia, hypertension and vasoconstriction. May lead to intracerebral or SAH) ```