PSYCHIATRIC PEER TUTORING 2017/18 - mental state findings, anxiety conditions, changes in behaviour/personality

Question 1

Question 1 - What is the answer? a Thought insertion f Pressure of speech b Auditory hallucination g Thought broadcast c Poverty of thought h Anhedonia d Delusions of grandeur i Thought withdrawal e Delusional perception j Flight of ideas 1. A patient describes the sensation of his head being empty and not being able to think.

Answer 1

C - Poverty of thought - patient is having difficulty forming thoughts here

Question 2

Question 1 - What is the answer? a Thought insertion f Pressure of speech b Auditory hallucination g Thought broadcast c Poverty of thought h Anhedonia d Delusions of grandeur i Thought withdrawal e Delusional perception j Flight of ideas 2. When talking to a patient you notice that they talk incessantly and you are unable to interrupt them.

Answer 2

F - Pressure of speech

Question 3

Question 1 - What is the answer? a Thought insertion f Pressure of speech b Auditory hallucination g Thought broadcast c Poverty of thought h Anhedonia d Delusions of grandeur i Thought withdrawal e Delusional perception j Flight of ideas 3. A patient describes hearing a voice that talks about them as if to someone else.

Answer 3

b - Auditory hallucinations If 3rd person, linked with schizoprehnia (link people are having a conversation about them behind them, running dialogue of what the patient is doing)

Question 4

Question 1 - What is the answer? a Thought insertion f Pressure of speech b Auditory hallucination g Thought broadcast c Poverty of thought h Anhedonia d Delusions of grandeur i Thought withdrawal e Delusional perception j Flight of ideas 4. A 33 year old presents to you with his partner who is concerned about his recent behaviour. He tells you that a greater being has chosen him to solve the world’s ills, and that he was chosen because of his superior intelligence.

Answer 4

D - Delusions of grandeur

Question 5

Question 1 - What is the answer? a Thought insertion f Pressure of speech b Auditory hallucination g Thought broadcast c Poverty of thought h Anhedonia d Delusions of grandeur i Thought withdrawal e Delusional perception j Flight of ideas 5. A 56 year old housewife tells you that, since her children have all moved away from home, she doesn’t enjoy activities that she previously took pleasure from.

Answer 5

H - Anhedonia - loss of enjoyment or interest in activities in which you previously took pleasure from

Question 6

Question 1 - What is the answer? a Thought insertion f Pressure of speech b Auditory hallucination g Thought broadcast c Poverty of thought h Anhedonia d Delusions of grandeur i Thought withdrawal e Delusional perception j Flight of ideas 6. A 33 year old cannabis user is brought to you by his mother who is concerned about him. She tells of how he has taken to hiding in his room and often tells her that people can hear what he is thinking.

Answer 6

G - Thought broadcasting

Question 7

Question 1 - What is the answer? a Thought insertion f Pressure of speech b Auditory hallucination g Thought broadcast c Poverty of thought h Anhedonia d Delusions of grandeur i Thought withdrawal e Delusional perception j Flight of ideas 7. A patient tells you that recently whilst he is talking to people he experiences the sensation of his mind going blank, that someone is taking the ideas from his head.

Answer 7

i - thought withdrawal

Question 8

Question 1 - What is the answer? a Thought insertion f Pressure of speech b Auditory hallucination g Thought broadcast c Poverty of thought h Anhedonia d Delusions of grandeur i Thought withdrawal e Delusional perception j Flight of ideas 8. A 43-year-old woman is brought to you by her husband. She tells you that she has been having ideas that are not her own. She states that she feels as though thoughts are being put into her head.

Answer 8

A - Thought insertion

Question 9

Question 1 - What is the answer? a Thought insertion f Pressure of speech b Auditory hallucination g Thought broadcast c Poverty of thought h Anhedonia d Delusions of grandeur i Thought withdrawal e Delusional perception j Flight of ideas 9. You notice a patient that you are talking to keeps jumping from one topic to another constantly with no apparent connection between them.

Answer 9

j - Flight of ideas

Question 10

Question 1 - What is the answer? a Thought insertion f Pressure of speech b Auditory hallucination g Thought broadcast c Poverty of thought h Anhedonia d Delusions of grandeur i Thought withdrawal e Delusional perception j Flight of ideas 10. A 47-year-old male patient tells you that he has realised that he was the messiah after hearing his phone ring three times.

Answer 10

E - Delusional perception

Question 11

1. 45 year old woman registers with a new GP and asks for a repeat prescription of diazepam which she has been taking for 10 years. When the GP tries to reduce the dose, she returns saying she is unable to cope. She is worried about her children’s school, bills to pay, and losing her job.

Answer 11

k - substance withdrawal

Question 12

How should you withdraw from a benzodiazepine?

Answer 12

Patient should be swtiched to an oral diazepam or chlordiazepoxide for withdrwal Then gradually reduce the dose every 2-3 wees by 2 to 2.5 mg, and maintain the dose if symptoms of withdrawal start to occur If withdrawal symptoms do occur, then wait till they disappear then reduce doses more gradually Finally able to stop the dose completely

Question 13

2. 36 year old man presents to the GP describing having a fear of new situations and meeting new people. He finds himself making excuses to avoid these situations or having a drink or two for “Dutch courage”.

Answer 13

Social phobia Fear of one or more social or performance situations in which you can be exposed to unfamiliar people or scrutiny Typically alcohol is consumed to try and give the patient some courage

Question 14

3. 60 year old woman is widowed after the sudden death of her husband. She initially doesn’t accept the death of her husband, but seems to cope very well with the funeral. The day after she is very teary and doesn’t know how she is going to cope.

Answer 14

j -Grief reaction

Question 15

4. 28 year old fireman presents to his GP to ask for his sickline to be extended. On further questioning he mentions he is unable to sleep at night due to having nightmares. He has been off work for the last 2 months, due to a road traffic accident which resulted in severe injury to a close friend. He doesn’t want to talk about what happened, and doesn’t feel he is able to face going back to work.

Answer 15

a - PTSD have a history of trauma * Then 1 symptom of intrusive thoughts - having nightmares * Then 3 symptoms of avoidance - taking time of work, doesn’t want to talk about it, avoiding reminders * Then 2 arousal symptoms - sleep disturbance, another will be elicited in history?

Question 16

How long does PTSD have to last for to be separate from acute stress disorder?

Answer 16

It has to last at one month before classified as acute stress disorder

Question 17

5. 20 year old woman presents to A&E with central chest pain, shortness of breath, nausea and sweating with no relief from GTN. ECG shows sinus tachycardia, Tropinin T is at 12 hours is <0.01.

Answer 17

e - Panic attack - troponin levels are far too low for acute coronary syndrome

Question 18

6. 40 year old man moves to Wales with his company. When he tries to visit friends and family in England, he develops palpitations and feeling of intense anxiety as he tries to drive across the Severn bridge, which are even worse if he tries to use the tunnel. He accepts that this fear is unfounded but is unable to overcome it.

Answer 18

d - agoraphobia This is a cluster of phobias embracing fears of leaving home, entering shops, crowds and public places, travelling alone in trains, buses or planes. Usually happens when in a situation where there is a fear of being unable to escape

Question 19

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Answer 19

A - delirium

Question 20

2. 54 year old chronic alcoholic is referred by his GP with abrupt onset short term memory loss. On examination he has is confused with an ataxic gait decreased conscious level, and CN 6th nerve palsy

Answer 20

f - Wernicke’s encephalopathy Due to a vitamin B1 deficiency, commonly caused by chronic alcoholism Presents with the triad of confusion, ataxia (wide based gait) and ophthalmoplegia (lateral rectus, nystagmus or conjugate gaze palsies)

Question 21

3. 72year old male with a chronic history of hypertension, ischaemic heart disease and several CVAs. He is brought to his GP by his wife with increasing behavioural problems, wandering and forgetfulness. His MMSE score is 17/30. The GP notes that 3months ago it was 21/30 and 6 months before that 24/30

Answer 21

j -Mutli infarct dementia Is shown to have a stepwise decline - following each vascular event usually

Question 22

4. 83yo female presents with an insidious onset of increased lethargy, mental slowness and general deterioration. On examination she is obese, pale, confused, speaks with a croaky voice and has an MMSE of 17/30. You note a recent FBC showed a macrocytosis.

Answer 22

C - hypothyroidism

Question 23

5. A previously fit 67 year old woman is taken by her husband to see her GP. He tells the doctor that for the past 7 months she has become increasingly forgetful, has word-finding problems and can no longer go out alone as she gets lost.

Answer 23

D - Alzheimers disease