Psych Revision Questions

Question 1

A 26 year old woman presents to her GP with a 4 year history of intermittent facial flushing, shaking, sweating and palpitations when giving presentations at work in front of her team. She now avoids these and this has negatively affected her work performance and she has thought about leaving her job. She feels fine in between episodes and denies any low mood symptoms. Which of the following diagnose and treatment would match this scenario?

1. Social Anxiety and CBT (Cognitive Behavioural Therapy)
2. PTSD and EMDR (Eye Movement Desensitisation Reprocessing)
3. Obsessive Compulsive Disorder and CBT with Exposure Response Therapy
4. Psychosis and CBT for Psychosis
5. Borderline Personality Disorder and Dialectical Behavioural Therapy (DBT)

Answer 1

1. Social Anxiety and CBT (Cognitive Behavioural Therapy)

Question 2

A 46 year old bus driver presents to A and E intoxicated with a broken finger after getting into a fight in the pub. He appears easily startled. On further questioning he breaks down and reports worsening sleep, irritability and vivid nightmares of a road traffic accident he was involved in whilst driving a bus 4 months ago where a young woman died. His relationship with his wife has deteriorated due to increased alcohol use. He has been avoiding work and has not managed to drive a vehicle since. Which of the following diagnose and treatment would match this scenario?

1. Social Anxiety and CBT (Cognitive Behavioural Therapy)
2. Borderline Personality Disorder and Dialectical Behavioural Therapy (DBT)
3. Psychosis and CBT for Psychosis
4. Obsessive Compulsive Disorder and CBT with Exposure Response Therapy
5. PTSD and EMDR (Eye Movement Desensitisation Reprocessing)

Answer 2

5. PTSD and EMDR (Eye Movement Desensitisation Reprocessing)

Question 3

A 17 year old student attend his GP with difficulty sleeping. He admits to spending hours in the evening turning off all the lights in the house before he can sleep. He may do this 4 or 5 times a night. This started 6 months ago after he started a drama scholarship but is getting worse and he is now having to do this in the morning and return home several times to check the house before he goes to college. This has made him late on several occasions. Prior to turning off the lights he experiences thoughts that are his own but he can’t resist. They are worries over his family dying or being hurt from a house fire that is his fault, after he has performed his checking his anxiety is reduced. Which of the following diagnose and treatment would match this scenario?

1. Social Anxiety and CBT (Cognitive Behavioural Therapy)
2. Borderline Personality Disorder and Dialectical Behavioural Therapy (DBT)
3. Psychosis and CBT for Psychosis
4. Obsessive Compulsive Disorder and CBT with Exposure Response Therapy
5. PTSD and EMDR (Eye Movement Desensitisation Reprocessing)

Answer 3

4. Obsessive Compulsive Disorder and CBT with Exposure Response Therapy

Question 4

A 28 year old man is brought to A and E by his girlfriend. She came home after a two week holiday to find him in the house surrounded by piles of shredded documents and letters. He told her that his mind and soul were under attack and he was in the middle of a war of higher powers so he had to protect them both by destroying confidential information. He is talking about demons attacking his soul and putting ideas in his mind through the TV and his phone. His speech is difficult to understand at points as he is changing topic quickly. Which of the following diagnose and treatment would match this scenario?

1. Social Anxiety and CBT (Cognitive Behavioural Therapy)
2. Borderline Personality Disorder and Dialectical Behavioural Therapy (DBT)
3. Psychosis and CBT for Psychosis
4. Obsessive Compulsive Disorder and CBT with Exposure Response Therapy
5. PTSD and EMDR (Eye Movement Desensitisation Reprocessing)

Answer 4

3. Psychosis and CBT for Psychosis

Question 5

A 27 year old man reports no improvement in his mood symptoms after being on many different antidepressants over the years. His main difficulties are rapid mood fluctuations throughout the day, especially triggered if he feels rejected by others. He has a history of chaotic and unstable relationships and gets angry quickly. He has been unable to sustain employment for longer than a few months. At times of heightened emotions he can become suicidal and has attended A and E many times for superficial lacerations and overdoses. He describes his mood as ‘numb and empty’. Which of the following diagnose and treatment would match this scenario?

1. Social Anxiety and CBT (Cognitive Behavioural Therapy)
2. Borderline Personality Disorder and Dialectical Behavioural Therapy (DBT)
3. Psychosis and CBT for Psychosis
4. Obsessive Compulsive Disorder and CBT with Exposure Response Therapy
5. PTSD and EMDR (Eye Movement Desensitisation Reprocessing)

Answer 5

2. Borderline Personality Disorder and Dialectical Behavioural Therapy (DBT)

Question 6

How many weeks maximum do NICE guidelines recommend Benzodiazepines are prescribed for an anxiety disorder?

1 - 2 weeks
2 - 4 weeks
3 - 8 weeks
4 - 12 weeks

Answer 6

2 - 4 weeks

Question 7

In treatment resistant schizophrenia, at least how many antipsychotics have to be tried before Clozapine can be prescribed?

1 - 2 antipsychotics (of which at least one should be a second generation)
2 - 4 antipsychotics (of which at least one should be a second generation)
3 - 2 typical and 2 atypical antipsychotics
4 - 1 atypical and 2 antipsychotics (of which at least one should be a second generation)

Answer 7

1 - 2 antipsychotics (of which at least one should be a second generation)

Question 8

In ICD 11 how long do you need to have persistent depressive symptoms for to meet criteria for depressive episode?

1 - 1 week
2 - 2 weeks
3 - 4 weeks
4 - 12 weeks

Answer 8

2 - 2 weeks

Question 9

What section of the MHA lasts for up to 6 months?

1 - section 2
2 - section 3
3 - section 5 (2)
4 - section 125

Answer 9

2 - section 3

Question 10

An IV heroin and cocaine user is engaging with their local community drug and alcohol team but is not ready to stop injecting drugs. There is no co morbid mental disorder. The patient is open to harm minimisation strategies. Please select the most immediate appropriate management option from below:

1 - Methadone
2 - Needle exchange system
3 - Buprenorphine
4 - Refer for admission
5 - Disulfiram

Answer 10

2 - Needle exchange system

Question 11

A 72 year old presents with severe depressive disorder. He has not responded to 3 antidepressants and augmentation with an antipsychotic. He has now been admitted to hospital under S2 MHA and has not eaten for 5 days and is only having occasional sips of water. Please select the most immediate appropriate management option from below:

1 - Electroconvulsive Therapy
2 - Lithium
3 - Cognitive Behavioural Therapy
4 - Clozapine
5 - Pregabalin

Answer 11

1 - Electroconvulsive Therapy

Question 12

A 78 year old RAF veteran presents to the memory clinic with an 18 month history of poor concentration, irritability, forgetting appointments and recent events. He now needs help to manage his finances. He has stopped cooking for himself as set fire to a pan after leaving it turned on. He has a history of peripheral vascular disease, T2DM and hypertension. His bloods are normal. His MRI scan shows severe small vessel disease and evidence of an old ischaemic infarct. Please select the most immediate appropriate management option from below:

1 - Donepezil
2 - Fluoxetine
3 - Optimisation of vascular risk factors
4 - Memantine
5 - DAT scan

Answer 12

3 - Optimisation of vascular risk factors

Question 13

An 81 year old woman with a history of Schizophrenia stopped taking her Haloperidol 3 months ago. She lives alone. She was referred to the crisis team but has stopped letting them in the house and is refusing to talk to her daughter who is her only support network. Last week she agreed to pay gardeners £8000 for a new patio as she believes the government have put microphones under her current one. She has not been sleeping well and her daughter is worried she has not bought food for over 2 weeks and is not taking her physical health medications. What would your immediate management be?

1 - Arrange a MHA assessment
2 - Electroconvulsive Therapy
3 - Detain under Section 5(2)
4 - Start depot medication
5 - Discharge back to community team

Answer 13

1 - Arrange a MHA assessment

Question 14

A 16 year old with a diagnosis of severe learning disability is referred to psychiatry. He is non verbal. He started hitting his head repeatedly on the wall a few weeks ago, which has caused a large haematoma on his forehead. He had an unwitnessed fall just prior to the self injurious behaviour. The staff report he is not eating as much and no longer enjoys playing football instead he lies in bed for much of the day and is reluctant to move. When he does move this usually precipitates him banging his head on the wall. Please select the most immediate appropriate management option from below:

1 - Start Fluoxetine 20mg
2 - Cognitive Behavioural Therapy
3 - Risperidone 0.5mg at night
4 - Detain under MHA
5 - Complete full physical health assessment

Answer 14

5 - Complete full physical health assessment

Question 15

A mood stabilising medication that has been linked to neural tube defects and other complications in developing foetuses so prescribing is now highly restricted in women.

1. Sodium Valproate
2. Aripiprazole
3. Lithium
4. Mirtazapine

Answer 15

1. Sodium Valproate

Question 16

A second generation antipsychotic often prescribed due to lower propensity to cause cardiac and metabolic side effects. A common side effect is agitation.

1. Sodium Valproate
2. Mirtazapine
3. Lithium
4. Aripiprazole

Answer 16

2. Aripiprazole

Question 17

A medication with a small therapeutic window. At high levels toxicity can occur with symptoms that include coarse tremor, nausea, confusion and vomiting.

1. Lithium
2. Sodium Valproate
3. Clozapine
4. Mirtazapine

Answer 17

1. Lithium

Question 18

An antidepressant which has common side effects of increased appetite, weight gain and improved sleep.

1. Mirtazapine
2. Chlordiazepoxide
3. Clozapine
4. Pregabalin

Answer 18

1. Mirtazapine

Question 19

What is the main Benzodiazepine used for alcohol withdrawal regimes.

1. Clozapine
2. Pregabalin
3. Donepezil
4. Chlordiazepoxide

Answer 19

4. Chlordiazepoxide

Question 20

On initiation this antipsychotic needs weekly blood tests to monitor neutrophils and can cause myocarditis. Ongoing blood monitoring is required whilst taking it.

1. Mirtazapine
2. Chlordiazepoxide
3. Donepezil
4. Clozapine

Answer 20

4. Clozapine

Question 21

Second line medication in NICE guidelines for Generalised Anxiety disorder, which is now a controlled drug due to risk of tolerance and dependency.

1. Lithium
2. Sodium Valproate
3. Pregabalin
4. Mirtazapine

Answer 21

3. Pregabalin

Question 22

First line medication for cognitive symptoms Alzheimer’s disease.

1. Chlordiazepoxide
2. Clozapine
3. Pregabalin
4. Donepezil

Answer 22

4. Donepezil

Question 23

A 21 year old flight attendant attends a sexual health clinic asking for the morning after pill. Her speech is rapid but interruptible and logical. The patient tells the nurse she had unprotected sex last night which is out of character for her. She spent £2000 on clothes 2 days ago. In the last week she has not eaten as much as usual and feels more energetic despite lack of sleep. On assessment there are no psychotic symptoms. She is able to function and has been working this week. This started one week ago after a series of long haul flights meant she barely slept for 5 days. She has no previous psychiatric history. Which of the following is the most likely diagnosis for the following patient?

A) Hypomania
B) Cyclothymia
C) Bipolar Affective Disorder
D) Mania
E) Schizoaffective Disorder

Answer 23

A) Hypomania

Question 24

A 5 year old girl is being reviewed in clinic. Her father is worried she is struggling at school. She becomes very upset in the morning and refuses to go in most days. Loud noises and labels on clothes distress her. She has not made any friends since starting in reception and prefers to play on her own with a specific type of toy from one TV show. On assessment her speech development is slightly delayed and she makes no eye contact. She often repeats words and sentences the doctor says. There are no concerns over her hearing or motor development. Which of the following is the most likely diagnosis for the following patient?

L) Attention Deficit Hyperactivity Disorder
M) Obsessive Compulsive Disorder
N) Autism Spectrum Diagnosis
O) Selective Mutism
P) Expressive Language delay

Answer 24

N) Autism Spectrum Diagnosis

Question 25

A 36 year old mechanic has recurrent episodes of psychosis over the past ten years necessitating 4 hospital admissions under the mental health act. During each episode he also presents with simultaneous prominent affective symptoms which occur within a few days of his psychotic symptoms. The affective symptoms have been both depressive and manic in nature. In between relapses of his psychosis there have been no mental health problems. He is now well on a combination of Quetiapine and Sodium Valproate.

I) Schizoaffective Disorder
J) Bipolar Type 1 Disorder
K) Schizotypal Disorder
L) Bipolar type 2 Disorder
M) Paranoid Schizophrenia

Answer 25

K) Schizotypal Disorder

Question 26

A single mother presents 4 days after giving birth to her GP with low mood, irritability, tearfulness and feeling exhausted. She worries she isn’t a good mother which is worse when her baby cries. This started 2 days after giving birth and this is her first child. She is quite isolated and has few local contacts but is currently able to care for the baby and herself. There are no risk concerns or psychotic symptoms.

L) Post Natal Depression
M) Depressive Episode
N) Post Natal OCD
O) Post Partum Psychosis
P) Baby Blues

Answer 26

P) Baby Blues

Question 27

A 45 year old woman has been drinking 2 bottles of wine a day for 20 years. She lost her bank card 2 days ago and has been unable to buy alcohol since. Her son visited her at home and finds her in bed crying and scratching at her arms. She is visibly sweating and her arms and legs are shaking. She is shouting that she wants him to take the spiders off her body and looks terrified. She is not orientated to time, place or person.

B) Wernicke’s Encephalopathy
C) Delirium Tremens
D) Subdural Haematoma
E) Alcohol withdrawal
F) Korsakoff’s Syndrome

Answer 27

C) Delirium Tremens