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Phase 3A - Specialities > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Give 3 of Schneider’s first rank symptoms of schizophrenia.

A

Auditory hallucinations: either 3rd person (voices discussing the patient) or 2nd person (voices telling the patient what to do)
Thought insertion or thought withdrawal
Thought broadcasting (the feeling that their thoughts are no longer private to them)
Passivity of affect, impulse or volition (actions are being controlled by someone else)
Somatic passivity
Delusional perception

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2
Q 
A patient tells you that they hear voices in their head. The voices are commentating on the patient and her actions, but not addressing her directly. What symptom does she have?
A. Thought insertion 
B. Thought broadcasting 
C. 2nd person auditory hallucination 
D. 3rd person auditory hallucination 
E. Delusional perception
A

D. 3rd person auditory hallucination

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3
Q 
A patient believes that their thoughts are no longer private and that other people around them are able to listen in. What symptom is this? 
A. Thought insertion 
B. Thought broadcasting 
C. 2nd person auditory hallucination 
D. 3rd person auditory hallucination 
E. Delusional perception
A

B. Thought broadcasting

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4
Q 
A patient tells you they have a voice in their head which is constantly criticising them and telling them to self-harm. What symptom is this? 
A. Thought insertion 
B. Thought broadcasting 
C. 2nd person auditory hallucination 
D. 3rd person auditory hallucination 
E. Delusional perception
A

C. 2nd person auditory hallucination

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5
Q 
A patient believes the government is placing ideas in their head as part of a wider plot to control them and their family. What symptom is this?
A. Thought insertion 
B. Thought broadcasting 
C. 2nd person auditory hallucination 
D. 3rd person auditory hallucination 
E. Delusional perception
A

A. Thought insertion

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6
Q 
A patient believes that a delivery van parked outside his house is actually being used by the Russians to spy on him. What symptom is this?
A. Thought insertion 
B. Thought broadcasting 
C. 2nd person auditory hallucination 
D. 3rd person auditory hallucination 
E. Delusional perception
A

E. Delusional perception

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7
Q 
Which of the following is a first generation neuroleptic?
A. Quetiapine 
B. Risperidone
C. Haloperidol
D. Olanzapine 
E. Clozapine
A

C. Haloperidol

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8
Q 
Which of the following is most likely to cause agranulocytosis?
A. Quetiapine 
B. Risperidone
C. Haloperidol
D. Olanzapine 
E. Clozapine
A

E. Clozapine

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9
Q 
Which of the following is most likely to cause tardive dyskinesia?
A. Quetiapine 
B. Risperidone
C. Haloperidol
D. Olanzapine 
E. Clozapine
A

C. Haloperidol (more common in 1st gen. anti-psychotics)

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10
Q 
Which of the following anti-psychotics is most likely to cause T2DM?
A. Quetiapine 
B. Risperidone
C. Haloperidol
D. Olanzapine 
E. Clozapine
A

D. Olanzapine

While clozapine and risperidone also can cause metabolic side effects, olanzapine is the most widely reported.

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11
Q 
Which of the following medications is indicated as the first line treatment for a depressive episode in a patient with bipolar disease?
A. Quetiapine 
B. Fluoxetine
C. Citalopram
D. Olanzapine 
E. Sertraline
A

A. Quetiapine

If you give a patient with bipolar an anti-depressant when they are in a depressive episode they will become manic

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12
Q 
Which of the following is a side effect you might be wary of in a patient on haloperidol?
A. Tardive Dyskinesia
B. Parkinsonism 
C. Dystonia
D. Akathisia
E. All of the above
A

E. All of the above

These are all extra-pyramidal side effects which are more commonly seen with typical (1st gen.) neuroleptics.

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13
Q 
Blockade of which neural pathway/tract by first generation anti-psychotics is responsible for their extra-pyramidal side effects?
A. The mesolimbic pathway
B. The mesocortical pathway
C. The nigrostriatal pathway
D. The pyramidal tract
E. The corticobulbar tract
A

C. The nigrostriatal pathway

The blockade of A and B is responsible for most of the anti-psychotic effects caused by 1st and 2nd gen. neuroleptics.

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14
Q 
Which receptors are targeted by both 1st and 2nd generation anti-psychotics?
A. Pre-synaptic D2 receptors
B. Post-synaptic D2 receptors
C. Pre-synaptic D1 receptors
D. Post-synaptic D1 receptors 
E. Dopamine receptors
A

B. Post-synaptic D2 receptors (a type of dopamine receptor)

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15
Q 
Which of the following anti-psychotics is licensed for treatment resistant schizophrenia?
A. Quetiapine 
B. Risperidone
C. Haloperidol
D. Olanzapine 
E. Clozapine
A

E. Clozapine

Due to it’s side effect profile it is reserved for treatment resistant cases or for when other anti-psychotics are not tolerated/contraindicated.

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16
Q 
Which of the following anti-psychotics is NOT available as a depot injection?
A. Quetiapine
B. Risperidone
C. Haloperidol
D. Olanzapine 
E. Flupenthixol
A

A. Quetiapine

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17
Q

Give 2 short term and 2 long term side effects of lithium use.

A

Short term: fatigue, dry mouth, metallic taste, polydipsia, weight gain, nausea and vomiting, fine tremor, polyuria, muscle weakness, oedema

Long term: thyroid disturbances, nephrotoxicity, memory disturbance, T wave flattening, arrythmias

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18
Q 
Which of the following blood levels is considered the therapeutic range for lithium?
A. 0-1.2 mmol/L
B. 1-2 mmol/L
C. 0.6-1.2mmol/L
D. 1.2-2.6mmol/L
E. 0.5-1.5mmol/L
A

C. 0.6-1.2mmol/L

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19
Q

a) Give 3 features of lithium toxicity.

b) in plasma levels >2mmol/L what else might you expect to see?

A

Drowsiness, ataxia, lack of coordination, blurrend vision, tinnitus, dysarthria, vomiting, diarrhoea, coarse tremor, muscle weakness and twitching

Above 2mmol/L: hyperreflexia and hyperextension of limbs, psychosis, convulsions, syncope, coma and death.

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20
Q 
Which of the following medications increase the risk of lithium toxicity if co-prescribed?
A. Ibuprofen
B. Ramipril
C. Fluoxetine
D. Amlodipine
E. All of the above
A

E. All of the above.

The following drugs increase the risk of lithium toxicity:
ACE-Is, ARBs, NSAIDs, SSRIs, anti-epileptics, anti-psychotics (esp. haloperidol), CCBs, diuretics, metronidazole.

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21
Q

A patient who is on lithium to treat bipolar disorder presents to A+E with the early signs of lithium toxicity. You find out that their GP recently started them on a medication to try and reduce swelling around their ankles.

a) Which type of medication might this be?
b) Why has it caused them to suffer lithium toxicity?
c) Give 3 symptoms the patient may be suffering from.

A

a) a thiazide or loop diuretic
b) diuretics reduce the renal excretion of lithium and so cause the plasma levels to rise.
c) 3 from:
Drowsiness, ataxia, lack of coordination, blurrend vision, tinnitus, dysarthria, vomiting, diarrhoea, coarse tremor, muscle weakness and twitching

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22
Q 
Which of the following medications may you use as a prophylactic in bipolar disorder when the patient is resistant to or intolerant of lithium?
A. Quetiapine
B. Sodium Valproate
C. Olanzapine
D. Carbamazepine 
E. Fluoxetine
A

D. Carbamazepine

This is indicated for the prophylaxis of bipolar in this scenario.

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23
Q 
Which of the following medications is a tricyclic anti-depressant?
A. Amitryptyline 
B. Fluoxetine 
C. Mirtazapine 
D. Duloxetine 
E. Quetiapine
A

A. amitryptiline

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24
Q 
Which of the following medications is an SSRI?
A. Amitryptyline 
B. Fluoxetine 
C. Mirtazapine 
D. Duloxetine 
E. Quetiapine
A

B. Fluoxetine

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25
Q 
Which of the following medications is an antagonist of inhibitory pre-synaptic a2-adrenoreceptors?
A. Amitryptyline 
B. Fluoxetine 
C. Mirtazapine 
D. Duloxetine 
E. Quetiapine
A

C. Mirtazapine (it’s a NaSSA)

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26
Q 
Which of the following is an SNRI?
A. Amitryptyline 
B. Fluoxetine 
C. Mirtazapine 
D. Duloxetine 
E. Quetiapine
A

D. Duloxetine

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27
Q 
Which of the following is licensed for treating generalized anxiety disorder? 
A. Amitryptyline 
B. Fluoxetine 
C. Mirtazapine 
D. Duloxetine 
E. Quetiapine
A

D. Duloxetine (SNRIs)

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28
Q 
Which of the following is licensed for the treatment of OCD?
A. Amitryptyline 
B. Fluoxetine 
C. Mirtazapine 
D. Duloxetine 
E. Quetiapine
A

B. Fluoxetine (SSRIs)

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29
Q 
Which of the following can be used in the treatment of neuropathic pain?
A. Amitryptyline 
B. Fluoxetine 
C. Mirtazapine 
D. Duloxetine 
E. Quetiapine
A

A. Amitryptiline (not licensed for this)

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30
Q 
Which of the following can increase appetite?
A. Amitryptyline 
B. Fluoxetine 
C. Mirtazapine 
D. Duloxetine 
E. Quetiapine
A

C. Mirtazapine

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31
Q

A patient on amitryptiline complains of developing increasingly blurred vision and a dry mouth.

a) which receptors have been blockaded by his antidepressant?
b) Give 3 other side effects of TCAs

A

a) muscarinic receptors

b) sedation, hypotension, QT-elongation, breast changes, sexual dysfunction.
There is also a risk of extra-pyramidal symptoms.

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32
Q

A patient with a history of depression presents to A+E complaining of a tremor which has come on over the last 12 hours. On examination they appear sweaty and restless. On examination they are ataxic, have brisk reflexes and slight muscle rigidity.

a) What is the likely diagnosis?
b) Give a medication which might cause this presentation.
c) Give a possible differential in this case and why it is not the example chosen

A

a) serotonin syndrome
b) MAOIs, Amphetamines, cocaine, MDMA, SSRIs, SNRIs, NaSSAs, LSD, Lithium

c) Neuroleptic malignant syndrome (minimal muscle rigidity and rapid onset)
Lithium toxicity (patient is restless not drowsy and has no GI symptoms that you expect to see in acute toxicity).
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33
Q 
A patient presents complaining of chronic 'lead pipe' muscle rigidity. Which of the following medications is NOT likely to be the cause?
A) Clozapine
B) Citalopram 
C) Olanzapine
D) Carbamazepine
E) Levodopa
A

B) Citalopram

All the others can cause neuroleptic malignant syndrome.

34
Q

A patient presents with chronic hyperthermia and hypertension. Their bloods show a metabolic acidosis and raised CK. What is the likely diagnosis?
A) Serotonic Syndrome
B) Lithium Toxicity
C) Neuroleptic Malignant Syndrome
D) Kidney failure
E) Rhabdomyolysis
(Bonus: What other diagnostic finding might you find on examination?)

A

C) Neuroleptic malignant syndrome
Bonus: find lead pipe rigidity on examination which is diagnostic in this case.

D and E are only partially correct, can both be a feature of NMS which is the best answer as it encompasses all the signs and symptoms.

A: Would expect to see more acute onset.
B: In an acute onset would expect to see more GI symptoms.

35
Q

A patient presents complaining of blurred vision and a ringing in her ears which has come on over the last month or so. On examination you notice she has a coarse tremor and appears ataxic. On reading her notes you see that she has previously complained of a metallic taste.

a) What is the likely diagnosis?
b) Give two symptoms that might develop should she go untreated?
c) Given the diagnosis what psychiatric condition may she suffer from?

A

a) Chronic lithium toxicity (neural symptoms suggest chronic onset, metallic taste is a common side effect of taking lithium)
b) Two from: hyper-reflexia, hyperextension, psychosis, oliguria, syncope, convulsions, coma and death.
c) Most likely is Bipolar disorder however lithium is indicated in resistant depression and mania/hypomania.

36
Q 
Which of the following is the target of benzodiazepines?
A) Dopaminergic receptors
B) Serotonin receptors 
C) B-adrenergic receptors
D) Muscarinic receptors 
E) GABA receptors
A

E) GABA receptors

37
Q

Why do benzodiazepines cause breathing difficulties?

A

They cause a loss of airway reflexes, leading to airway obstruction.

38
Q 
Which of the following is the first-line treatment for alcohol withdrawal? 
A) diazepam,
B) temazepam,
C) lorazepam,
D) chlordiazepoxide,
E) midazolam
A

D) chlordiazepoxide

39
Q 
Which of the following benzodiazepines is short-acting? 
A) diazepam,
B) temazepam,
C) lorazepam,
D) chlordiazepoxide,
E) midazolam
A

E) midazolam

40
Q 
Which of the following is indicated in the treatment of seizures?
A) diazepam,
B) temazepam,
C) midazolam
D) chlordiazepoxide,
E) All of the above
A

A) Diazepam

41
Q 
Which of the following Sections lasts 6 months and can be renewed?
A) Section 136
B) Section 2
C) Section 3
D) Section 4
E) Section 5(2)
A

C) Section 3

Purposes – treatment
 Higher burden of evidence needed as more liberties are removed
 Professionals involved – 2 doctors (one S12, one F2 and above), 1 AMHP
 Evidence required:
(a)The patient is suffering from mental disorder of a nature or degree which makes it appropriate for
the patient to receive medical treatment in a hospital; and
b) The treatment is in the interests of his or her health and safety and the protection of others; and
c) Appropriate treatment must be available for the patient

42
Q 
Which of the following sections is used by the police?
A) Section 136
B) Section 2
C) Section 3
D) Section 4
E) Section 5(2)
A

A) Section 136

Police section
 S136 – person suspected of having mental disorder in a public place
 S135 – needs court order to access patient’s home and remove them
 Removed to a place of Safety (local psychiatric unit or police cell)
 Further assessment? Need Section 2 or 3

43
Q 
Which of the Sections is used for assessment and where needed treatment?
A) Section 136
B) Section 2
C) Section 3
D) Section 4
E) Section 5(2)
A

B) Section 2

Purposes – assessment (although treatment can be given without patients’ consent)
 If patient volunteers to come in for assessment then no need for a section.
 Professionals involved - 2 doctors (one S12 approved, others can be F2 and above), AMHP
 Evidence required:
a) The patient is suffering from a mental disorder of a nature or degree that warrants detention in
hospital for assessment; and
b) The patient ought to be detained for his or her own health or safety, or the protection of others

44
Q 
Which of the following sections can be used by a doctor to stop a patient self-discharging for 72 hours?
A) Section 136
B) Section 2
C) Section 3
D) Section 4
E) Section 5(2)
A

E) section 5(2)

For a patient ALREADY admitted (can be psychiatric or general hospital) but wanting to leave
 Doctors’ holding power
 Allows time for Section 2 or Section 3 assessment
 Cannot be coercively treated (as in given medicine against their will)

45
Q 
Which section is used in an urgent situation to prevent an 'undesirable delay' in keeping the patient in hospital, such as waiting for a second doctor. 
A) Section 136
B) Section 2
C) Section 3
D) Section 4
E) Section 5(2)
A

D) Section 4

Purposes – only in an “urgent necessity” when waiting for a second doctor would lead to
“undesirable delay”
 Professionals required – 1 doctor and 1 AMHP

Evidence required:
a) The patient is suffering from a mental disorder of a nature or degree that warrants detention in
hospital for assessment; and
b) The patient ought to be detained for his or her own health or safety, or the protection of others
c) There is not enough time for 2nddoctor to attend (risk)

46
Q

You are an F2 working a night in A+E when a patient is admitted following an attempt to hang himself. He is found to be suffering from 3rd person auditory hallucinations telling him to kill himself and is agitated and aggressive. He is trying to self-discharge so he can ‘finish the job’. The on-call psychiatrist is currently seeing a patient on the other side of town and could be some time.

a) Which section would you use in this case?
b) How long does the section last?
c) Could you treat the patient coercively in this case?

A

a) Section 5(2) would be your best option.
b) 72 hours
c) No, you cannot treat a patient against their will on a section 5(2)

47
Q

You are an F1 working a night shift in A+E. A floridly psychotic and paranoid patient has been seen by an S12 trained doctor who believes they need to be admitted to hospital against their will for an assessment. He asks whether you would be happy to be a counter-signature on the form.

a) What type of Section might he be considering?
b) Give a piece of evidence needed in enacting this section.
c) Are you able to counter-sign this form?

A

a) Section 2, this allows for a patient to be admitted against their will for assessment.

b) The patient is suffering from a mental disorder of a nature or degree that warrants detention in
hospital for assessment.
OR…
The patient ought to be detained for his or her own health or safety, or the protection of others

c) No, only F2s and above can act in this capacity.

48
Q

You are an F2 working in A+E. A patient with known schizophrenia is admitted to the department in a severely psychotic state having been found walking in the road naked trying to catch passing cars and cyclists. The consultant psychiatrist who is on-call attends and decides they need to be admitted to the psychiatric ward for treatment.

a) What Section is the most appropriate?
b) What evidence is needed to support this section?
c) Can you act as a counter-signatory on the form?
d) The patient spends 4 months on the inpatient ward, how much longer does the section last and then what happens?

A

a) Section 3, for admission with a view to treatment.

b) - The patient is suffering from mental disorder of a nature or degree which makes it appropriate for
the patient to receive medical treatment in a hospital; and
- The treatment is in the interests of his or her health and safety and the protection of others; and
- Appropriate treatment must be available for the patient

c) Yes, you are an F2 so it is possible.
d) 2 months, case is then reviewed by a tribunal who decide whether to renew the section or not for another 6 months.

49
Q

A patient believes the shadows cast on their wall by a tree outside their room are actually the shadows of zombies. Are they suffering from a hallucination or an illusion?

A

Illusion

This is a clear example of a misperception of something that is already there.

50
Q

A patient reports seeing small people running up the bed-cover towards them as they fall asleep. What type of hallucination is this?
A) A Lilliputian hallucination
B) A hypnopompic lilliputian hallucination
C) A hypnogogic lilliputian hallucination
D) A reflex hallucination
E) An illusion

A

B) A hypnopompic lilliputian hallucination
- Hypnopompic means a hallucination as someone falls asleep.

A) it is a lilliputian hallucination but this is not the best answer
C) this means she is waking up
D) this is where a sensation in one modality is seen/felt in another
E) patient does not have a misperception

51
Q 
A patient says that whenever they hear a car alarm they feel insects crawling under their skin. What type of hallucination is this? 
A) A lilliputian hallucination
B) An auditory hallucination 
C) A reflex hallucination 
D) A pseudo-hallucination 
E) A visual hallucination
A

C) A reflex hallucination

An input in one sensory modality leads to a hallucination in another modality.

52
Q 
A patient reports that they hear voices offering a running commentary of everything they do. These voices are often critical. What are they experiencing?  
A) 2nd person auditory
B) 3rd person auditory 
C) Reflex hallucination 
D) A persecutory delusion 
E) A paranoid delusion
A

B) 3rd person auditory hallucination

53
Q 
A patient says that the police are going to arrest them for being a paedophile and are about to arrest him?
What is he suffering from?
A) 2nd person auditory
B) 3rd person auditory 
C) Reflex hallucination 
D) A persecutory delusion 
E) A paranoid delusion
A

D) persecutory delusion (belief that an external agency is pursuing them)

54
Q 
A patient says that their neighbour is collecting information on them and is going to accuse them of being a paedophile. What are they suffering from?
A) 2nd person auditory
B) 3rd person auditory 
C) Reflex hallucination 
D) A persecutory delusion 
E) A paranoid delusion
A

E) A paranoid delusion

55
Q 
A manic patient believes that they are a millionaire after they made money as a famous rock star. What type of delusion is this?
A) Misidentification
B) Grandiose
C) Hypochondrial
D) Guilt
E) Nihilistic
A

B) Grandiose

56
Q 
A patient believes that their wife has been replaced with a new Google robot which is monitoring him. What type of delusion is this?
A) Misidentification
B) Grandiose
C) Hypochondrial
D) Guilt
E) Nihilistic
A

A) misidentification

57
Q 
A patient has stopped eating and drinking as they are already dead. What type of delusion is this?
A) Misidentification
B) Grandiose
C) Hypochondrial
D) Guilt
E) Nihilistic
A

E) Nihilistic

58
Q 
A patient is convinced that every time they are touched by another person that person will develop a brain tumour. What type of delusion is this?
A) Misidentification
B) Grandiose
C) Hypochondrial
D) Guilt
E) Nihilistic
A

D) Guilt

59
Q 
A psychiatric patient with a tension headache is convinced that this means that they have got cancer in their head. What type of delusion is this? 
A) Misidentification
B) Grandiose
C) Hypochondrial
D) Guilt
E) Nihilistic
A

C) Hypochondrial

Belief that they have disease or another form of trauma converted from another condition.

60
Q

A patient believes that MI6 are trying to put thoughts to kill their mother into their heads.
What thought disturbance are they suffering from?
A) Insertion
B) Withdrawal
C) Broadcast
D) Echo
E) Block

A

A) insertion

An external agency is putting thoughts in their head.

61
Q

A patient believes that the police are able to take their thoughts and are using them to find out their pin code.
What thought disturbance are they suffering from?
A) Insertion
B) Withdrawal
C) Broadcast
D) Echo
E) Block

A

B) Withdrawal

62
Q

A patient believes that the mafia are able read their thoughts as they are no longer private and are using them to find out their pin code.
What thought disturbance are they suffering from?
A) Insertion
B) Withdrawal
C) Broadcast
D) Echo
E) Block

A

C) Broadcast

63
Q

A patient reports being able to hear their thoughts repeat themselves and find it very distracting.
What thought disturbance are they suffering from?
A) Insertion
B) Withdrawal
C) Broadcast
D) Echo
E) Block

A

D) Echo

64
Q

A patient is speaking to you about his housing situation however he suddenly stops and moves onto how he is finding his medications. When you ask him to tell you more about his flat he is unable to pick up from where he left off.
What thought disturbance are they suffering from?
A) Insertion
B) Withdrawal
C) Broadcast
D) Echo
E) Block

A

E) Block

65
Q

You are an F2 in A+E who sees a patient with a history of alcohol abuse. He tells you how over the weekend he was at home decorating his living room ceiling and fell off the ladder, causing him to hit his head. However, from the ambulance report you see he had in fact been drunk and had fallen over in the street.

a) What psychiatric symptom is he exhibiting?
b) What might be the condition causing this symptom?
c) What physical signs might you expect to find?
d) What is the name of the condition causing his physical signs?
e) How would you treat this patient?

A

a) Confabulation
b) Korsakoff’s Syndrome
c) double vision, ptosis, ataxia (with gait disturbance)
d) Wernicke’s Encephalopathy
e) IV or oral thiamine supplementation and referral to alcohol cessation services.

66
Q

A patient can feel tingling in their feet and believe it is due to a tracking device a spy placed on them. What symptom are they exhibiting?
A) Somatic Passivity
B) Psychomotor retardation
C) Made act
D) Made feeling
E) Stupor
(Bonus: What condition is it significant in for diagnosis?)

A

A) Somatic Passivity

It is a 1st rank symptom of Schizophrenia.

67
Q 
You see a patient with low mood who the nurses report has been very slow in her movements and speech over the past few days. What symptom might she be exhibiting?
A) Somatic Passivity 
B) Psychomotor retardation 
C) Made act
D) Made feeling 
E) Stupor
A

B) Psychomotor retardation

seen in severe depression

68
Q 
A patient has been admitted to A+E with severe burns to his hands after he set fire to his sofa. He claims he did this because MI6 told him to as there was a terrorist listening device hidden in there. What symptom might he be exhibiting? 
A) Auditory Hallucination
B) Persecutory delusion
C) Made act
D) Made feeling 
E) Paranoid delusion
A

C) Made act

A) no indication any voices were involved
B) he has acted on instructions rather than as a reaction to a delusion
D) he reports an act and not a feeling
E) Same reason as B, he is not clearly paranoid but he did receive instructions to act.

69
Q

A teenager presents to A+E with a pulse of 50bpm and a BP of 84/57. On examination you find she has a BMI of 14. From the history you establish that she has been terrified of becoming fat and so you diagnose her with anorexia nervosa.

a) Give 2 signs you might find on examination.
b) Give 2 ways in which she might have tried to lose weight.
c) What type of psychiatric symptom is her morbid fear of becoming obese?
d) From the information above why is it more likely that this patient is suffering from anorexia nervosa and not bulimia nervosa?
e) Give one psychiatric and one physical differential for anorexia nervosa.

A

a) Laguno hair on face and trunk, cachexia, muscle wasting, angular stomatitis, reduced growth, poor peripheral circulation.
b) restriction of intake, self-induced vomiting, self-induced purging, excessive exercise, use of appetite suppresants/diuretics.
c) overvalued idea
d) Patients with bulimia will typically have a normal or slightly raised body weight.

e) psych: depression, OCD, personality disorder
physical: neoplasia, hyperthyroid, intracranial SoL,
malabsorption syndrome, Crohn’s/UC

70
Q

A 27 year old female has presented to A+E complaining of chest pain which is worse on swallowing and breathing. It does not radiate anywhere and came on after she had just been for a large meal with her friends. On examination you find she is taking rapid, shallow breaths and has an irregular pulse. You also notice that she has thickened skin on her knuckles and swollen salivary glands.

a) What is the most likely cause of this woman’s presentation?
b) What is the underlying psychiatric diagnosis?
c) Would you expect her to be significantly underweight?
d) What is the probable cause of her irregular pulse?

A

a) Oesophgeal tear

b) Bulimia nervosa
Thickened skin on the knuckles is from inducing vomiting, which leads to her swollen salivary glands. She also reports it came on after a ‘large meal’, patients will often induce vomiting when they feel guilty about feeling excessively full.

c) No. Patients with bulimia are often normal/slightly overweight
d) Low K+ and Ca2+ from excessive vomiting

71
Q

Give 3 possible psychological treatment options for someone with an eating disorder.

A

Psychotherapy, CBT, family therapy, group psychotherapy, self-help groups, behavioural treatments, anxiety management. interpersonal therapy.

72
Q

You are an F1 on rotation in psychiatry and take a history from a patient with borderline personality disorder (BPD), Miss M. You discover that from an early age she would find herself abandoned by her parents who were both heroin addicts. She was eventually placed into foster care at age 7 but exhibited difficult behavior which meant she moved regularly. Around 11 she was sexually abused by one of her carers until she moved homes again.

a) Give 3 characteristics of BPD.
b) Explain attachment theory in relation to her case.
c) What primitive defensive mechanism might patients with BPD use? (Bonus: and explain it…)

A

a) Chronic feeling of emptiness and boredom, disturbed self-image, intense and unstable relationships, unstable mood (dysthymia). May suffer emotional crises when relationships break down, significant history of self-harm/suicide and psychoactive substance abuse.
b) States that for normal emotional development a child needs a caregiver to help them learn how to interact emotionally and socially with the world. Miss M has had no primary caregiver and so did not learn to regulate her emotions or how to interact socially from a young age. In addition she was abused by a potential care giver, a common finding in a history of BPD. (https://en.wikipedia.org/wiki/Attachment_theory)

c) splitting: repressed thoughts or wishes are projected onto an external object.
Projective identification: sees another person as possessing repressed aspects of the self and constrains the other person to take on those aspects.

73
Q 
Which of the following personality disorders features a lack of close, confiding relationships, emotional coldness and a tendency to have eccentric interests. 
A) Anankastic
B) Schizoid
C) Anxious 
D) Histrionic
E) Antisocial
A

B) Schizoid

74
Q 
Which of the following personality disorders features a tendency to be overly theatrical, manipulative and to crave attention?
A) Anankastic
B) Schizoid
C) Anxious 
D) Histrionic
E) Antisocial
A

D) Histrionic

75
Q 
Which of the following personality disorders features a tendency for perfectionism, pedantry and stubborness?
A) Anankastic
B) Schizoid
C) Anxious 
D) Histrionic
E) Antisocial
A

A) Anankastic

76
Q 
Which of the following personality disorders features self-consciousness, hypersensitivity to rejection and an anger at oneself for not developing friendships? 
A) Anankastic
B) Schizoid
C) Anxious 
D) Histrionic
E) Antisocial
A

C) Anxious

77
Q 
Which of the following personality disorders features a low threshold for anger and aggression and a tendency to be irresponsible.
A) Anankastic
B) Schizoid
C) Anxious 
D) Histrionic
E) Antisocial
A

E) Antisocial

78
Q

What is the key difference between obsessive-compulsive disorder and obsessive-compulsive (anankastic) personality disorder?

A

People with OCD have insight into their condition whereas people with anankastic personality disorder do not.

79
Q

A 56 year old gentleman presents to A+E where you are working having been found collapsed in the street. On examination he has a distended abdomen and has numerous bruises on his arms and legs. As he sobers up he tells you how he has struggled with alcohol dependency having lost his job 4 years ago and lives alone with no close friends or family nearby. He describes his mood as low at around 4/10 and can’t remember the last time it got above a 6/10.

a) Give 3 risk factors for suicide in this gentleman.
b) Suggest a tool you may use to assess his level of alcohol use.
c) What might explain the bruises on his arms and legs?
d) If bruising were to develop around his umbilicus what might this indicate?

Two days later on the ward he develops a coarse tremor and begins to sweat profusely. He reports small soldiers on his bed and is agitated.

e) What is the diagnosis?
f) What type of hallucination is this?
g) Which class of drug might you use to treat it and give the 1st line option.

A

a) male, lives alone, unemployed, alcohol dependency, depression, no friends or family, single, over 45 years old.
b) CAGE or AUDIT
c) A deficiency in Vitamin K leading to reduced platelet functioning.
d) Pancreatitis (Cullen’s Sign)
e) Delirium tremens
f) Lilliputian hallucination
g) Benzodiazepines - chlordiazepoxide first line

80
Q

What are 3 signs of foetal alcohol syndrome?

A

Microcephaly, flattened filtrum, strabismus, small nose, pectus excavatum, mild to moderate retardation, cardiac murmurs (ASD), poor growth

81
Q

Define ‘cyclothymia’.

A

A disorder where a patient’s mood swings between short periods of mild depression and hypomania, an elevated mood. The low and high mood swings never reach the severity or duration of major depressive or full mania episodes.

82
Q

A patient with a history of depression comes to see you in you GP clinic. They are convinced that they are now penniless after some investments went wrong and that their close friends have abandoned them.

a) What type of delusion is this?
b) Give another type of delusion that falls under this category.

A

a) A nihilistic delusion (aka Cotard’s Syndrome)

b) Patient feels as thought they are dead, organs don’t work, parts of the body are missing etc.

Phase 3A - Specialities (6 decks)

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