Psych PPQs Flashcards
Patient had knee surgery was not taking usual drug for anxiety disorder. Now she has coarse tremors, agitated, can’t sleep. What class of drugs is she not taking now?
Benzodiazepines
A man with severe depression develops the belief that his body is rotting. What type of delusion is this?
Nihilstic delusions/cotard delusion
- Loss of libido. DHx COCP Cetirizine Salbutamol inhaler. What is the cause of loss of libido?
Cetirizine
What drugs can cause a loss of libido?
Cetirizine
- Boy with conduct disorder is most likely to get what personality disorder when older?
Antisocial personality disorder
10 days after having baby – feels teary and not sure why she is feeling like this about the baby?
Baby blues
- Man presents with itching but no cause. In the past has presented with tingling, headache, and abdominal pain.
Somatisation disorder (functional symptoms)
- Deficiency of what vitamin would cause visual disturbances, ataxia and confusion
Thiamine (B1 deficiency). Seen in alcoholics
Test to do in woman who is scantily dressed, agitated, sweating, tachycardic
TFTs
- Woman with learning difficulties in a care home with change in behaviour: change in feeding time and irritability because the carer that was looking after them has gone suddenly, what’s the diagnosis?
Challenging behaviour in reaction to the change
- Woman with anorexia was admitted and she started eating. Then she gets muscle spasms, and abdominal pain. What’s the most important thing to check for?
Low phosphate? Low potassium? Refeeding syndrome
- Drug to give for depression in a man who had a previous MI
Sertraline
- Old age boxer rips out cannula, attacks staff what do you do?
Calm him with verbal de-escalation
- Someone else kicking off and de-escalation has failed, what drugs?
Intramuscular Lorazepam
- What does clozapine cause?
Neutropenia (agranulocytosis)
- Man whose wife died a year ago, has 6 months of low mood, low energy, doesn’t like doing what he used to, getting forgetful, lacking concentration
Abnormal (prolonged) grief reaction
- Man on haloperidol gets acute dystonia - treatment?
Procyclidine
- Woman experienced trauma 6 months ago/has PTSD best management?
EMDR (CBT and SSRI weren’t options)
- Man works as an IT engineer, doesn’t like sex, or people
Schizoid personality disorder
What is schizotypal personality disorder?
Eccentric thoughts and beliefs
Man worries about running kids over so has to check the road or every time
OCD
Woman drops out of uni, goes back home lives with mother and accuses mother of poisoning her: Schizoid personality disorder, acute psychosis, prodromal schizophrenia/ at-risk mental state
Acute psychosis
- Woman comes to A&E overdose after argument with boyfriend, previous history of overdosing - diagnosis?
EUPD
- Woman blushes in public and becomes very nervous around people
Social phobia (repeat, though previous year question asked what was most associated with social phobia – answer was blushing)
Man has a fear of public speaking, worried about embarrassing himself, hasn’t seen his personal tutor, hasn’t left the house in a few? weeks, gets sick thinking about it. social phobia, agoraphobia, avoidant personality disorder
Social phobia
Woman has been spending more money, lots of energy, little sleep, going on for 6 weeks but not affecting her work (although feels more imaginative)
Hypomania
- Old woman in care home, no PMH, no psych history, nurses complain she wakes up in night and sleeps in day- what do you do first?
Advise on sleep hygiene
- A 25 year old students with asthma/diabetes, stressed about exams for 6 weeks and his exams are coming up in 2 weeks. What do you do? watch and wait, CBT, beta blocker, Benzodiazepines, Sertraline
???
Woman is anorexic (14.3 BMI) – discharge to GP, discharge to CAMHS, use the MHA and feed her, routine referral to eating disorder clinic, emergency CAMHS, urgent referral to A&E?
Urgent referral to A&E
- The police want to detain someone under the MHA in public, which MHA section?
Section 136
The police want to detain someone under the MHA from a private residence, which MHA section?
Section 135
- Woman on venlafaxine, starts developing symptoms of mania (BAD), what do you do first? Stop the Venlafaxine (other options: give lithium, refer to community mental health team)
Stop the Venlafaxine
- 50 year old known alcoholic wanders in screaming he sees ants and tiny men running around?
Delirium tremens
- Alcoholic wants to quit and wants something for reducing cravings
Acamprostate
Patient with Lewy body dementia, given a drug that makes him worse, what drug?
Haloperidol
Man on antipsychotic comes in with tremor – most likely drug
Haloperidol (any typical anti-psychotics)
- A few questions on people with learning disabilities coming in with carers/families and their carers/families disagreeing with the doctor’s plan so what would you do first?
(ALWAYS assess capacity- everyone is assumed to have capacity until proven otherwise)
- Kid is very disruptive in class/at home/has trouble organizing himself, what’s the diagnosis?
ADHD
- Child has classic symptoms of ADHD, how do you manage?
Family therapy
Man writes letters to the PM, think he’s being spied on by the government for the past 10 years, shows no other symptoms
Delusional disorder
- Man comes requesting for codeine for his back, concerned his painkiller use is spiralling, see some degeneration in his spine on imaging – what do you do?
Buprenorphine + addiction clinic referral
- What would an alcoholic need to have to be classified as being dependent?
Giving up pleasurable activities to drink more alcohol (there are more criteria but this was the only one in the options)
- Man has recurrent mental images of child pornography, finds them deeply distressing, seeking help
OCD
- Man with history of paranoid schizophrenia, his Ix and tests are strongly suggestive of an MI, needs treatment. He has capacity and refuses treatment – what should you do?
Respect his wishes if it is a capacitous decision
- Someone with dilated pupils, urinary retention, obs normal-ish - cause of overdose?
TCA/amitryptaline
- Lithium – what do you monitor?
Serum Lithium levels every 3 months, U&Es, BMI, and TFTs every 6 months
- Husband brings in wife who has bipolar, who’s taken 20 “white” tablets - has a tremor, hyperreflexia, and confusion. What tablet has she overdosed on?
Lithium
- Patient on ward becomes aggressive, verbal de-escalation hasn’t worked. Treatment?
IM Lorazepam
- 50y lady fell over gardening, comes in with paralysis of leg, no medical cause found?
Conversion disorder/dissociative disorder
- Man who drinks a bottle of wine a day for the last 10 years, has tried to quit before but failed. Wants to cut down.
Initially motivational interviewing, then inpatient chlordiazepoxide when ready to fully quit
- 16 y o having sex with a 12 year old, what is your next action?
Inform the police
- Woman comes in with a pneumothorax and said her husband kicked her and has previously hurt their baby too. Baby is currently at home with him – what do you do?
Phone police, call social services, send her home??
Phone police, call social services?
Boy always playing video games from teenage years, not interested in other people threatening to kill himself?
Schizoid personality disorder
Person sees flower on wallpaper but perceives it as moving snakes
Illusion
Person sees things smaller?
Micropsia
- Definition of feel insects under skin
Formication
Young Woman who has come into A&E multiple times with different presentations, nothing found for any of them
Somatisation disorder
- Woman with abdominal pain, weight loss, lethargy and feeling low
Malignancy
Man who drinks and takes some drugs. Split up with girlfriend, cutting
EUPD
50 y woman with constant stomach pain, had many ix e.g. multiple laparoscopies with nothing found. Comes to A&E saying she needs another laparoscopy
Muchausen’s
- Addict patient presenting with dilated pupils and goosebump flesh
Opiate withdrawal
Neuroleptic Malignant Syndrome – recently started on antipsychotic what test would you do?
Creatinine kinase
Acute treatment for patient with manic episode
Olanzapine
What is moderate retardation defined as?
30-49
What is mild retardation defined as?
50-69
- Woman with depressive episode in the past and was given antidepressants. Is now presenting to the GP wearing bright clothes, saying she is going to divorce her husband and move abroad – what is the diagnosis?
BPAD