Revision Questions Flashcards
- A rather thin young student presents to her GP complaining that she has not had a menstrual period for over a year although she is not taking the contraceptive pill. She has been ‘very stressed’ by her university course but is still doing well academically, and belongs to the University triathlon club. She becomes tearful when the GP suggests weighing her, and insists she eats very well, indeed she finds herself often eating far more than she intended and is worried that she may gain weight. Blood results are normal apart from a low potassium value, low total white count and mild neutropaenia and slightly low TSH. The most likely diagnosis is:
A. Hyperthyroidism B. Bulimia nervosa C. Anorexia nervosa: restrictive type D. Tuberculosis E. Anorexia nervosa: binge-purge subtype
E. Anorexia nervosa: binge-purge subtype
- You are an FY2 in a general surgical ward. You have decided to detain one of your patients under the Mental Health (Care and Treatment) (Scotland) Act 2003. Which of the following is the most appropriate order to use?
A. Emergency Detention Certificate B. Short Term Detention Certificate C. Transfer for Treatment Direction D. Guardianship Order E. Section 47 Incapacity Certificate
A. Emergency Detention Certificate
- A woman presents hearing the national anthem playing when there is no music in the house. Which of the following symptoms is this an example of?
A. Idea of reference B. Delusion of grandeur C. Anhedonia D. Auditory hallucination E. Pseudohallucination
D. Auditory hallucination
- An 80 year old man is admitted with weight loss, poor motivation, social isolation, lack of interest in bowling which he previously did regularly, suicidal ideation and tearfulness. Which of the following is the most likely diagnosis:
A. Anorexia nervosa B. Bulimia nervosa C. Cerebellar stroke D. Depression E. Alzheimers’ Disease
D. Depression
- A 20 year old man is arrested by the police following stabbing his neighbor whom he believes is an alien who is poisoning the neighbours with gases from his home planet. He is assessed by the on-call forensic psychiatrist in the court cells who decides to admit him to hospital what order should be used?
A. Emergency Detention Certificate B. Short Term Detention Certificate C. Transfer for Treatment Direction D. Treatment Order E. Assessment Order
E. Assessment Order
- A 20 year old man with no history of illicit drug use is admitted believing his neighbour is an alien who is poisoning with gases from his home planet. The man says he can smell the gas in the hospital and his neighbour is speaking to him through the wardrobe telling him to harm others. He believes his neighbour is putting thoughts into his mind.Which of the following is the most likely diagnosis?
A. Paranoid Schizophrenia B. Simple Schizophrenia C. Hebephrenic Schizophrenia D. Drug induced Psychosis E. Persistent Delusional Disorder
A. Paranoid Schizophrenia
- The 20 year old patient with beliefs that his neighbour is an alien poisoning him with gas is deemed to require treatment. Which of the following drug types is the most appropriate treatment?
A. Mood stabilizer B. Clozapine C. Atypical Antipsychotic D. Typical Antipsychotic E. Antidepressant
C. Atypical Antipsychotic
- A soldier who has recently returned from active combat attends his GP as he has frequent nightmares, startles easily, tries to avoid his army friends and anything to do with his job and is always on edge. What is the likely diagnosis?
A. Depression B. Mania C. Generalised Anxiety Diroder D. Military Phobia E. Post Traumatic Stress Disorder
E. Post Traumatic Stress Disorder
- A 38 year old woman has consulted her GP and a diagnosis of moderate depression has been made. Which of the following would be an appropriate first-line treatment?
A. Lithium B. Sertraline C. Clozapine D. Phenelzine E. Venlafaxine
B. Sertraline
- Which of the following psychological treatments is recommended in the first line treatment of depression?
A. Brief Psychodynamic Psychotherapy B. Unstructured Counselling C. Mentalisation Based Therapy D. Cognitive Behaviour Therapy E. Exposure and Response Prevention
D. Cognitive Behaviour Therapy
A 32 year old woman has been regularly attending her GP over 6 months having initially experienced a panic attack. She often describes having a tight chest and difficulty breathing. For several months she has been feeling irritable, often wakening through the night concerned about her work where she is struggling to concentrate.
Your assessments include an investigation of anxiety symptoms.
- Name three psychological symptoms that might be experienced in an anxiety disorder (3)
Fearful Anticipation, Irritability, Sensitivity to Noise, Poor Concentration, Worrying Thoughts
A 32 year old woman has been regularly attending her GP over 6 months having initially experienced a panic attack. She often describes having a tight chest and difficulty breathing. For several months she has been feeling irritable, often wakening through the night concerned about her work where she is struggling to concentrate.
Your assessments include an investigation of anxiety symptoms.
- Give three examples of gastro-intestinal symptoms that may be experienced in anxiety (3)
Dry Mouth, Difficult Swallow, Dyspepsia, Nausea or Wind, Frequent Loose Stools
A 32 year old woman has been regularly attending her GP over 6 months having initially experienced a panic attack. She often describes having a tight chest and difficulty breathing. For several months she has been feeling irritable, often wakening through the night concerned about her work where she is struggling to concentrate.
Your assessments include an investigation of anxiety symptoms.
- In considering a diagnosis of an anxiety disorder, list three differential diagnoses of physical conditions? (3
Thyroxocisosis, Phaeochromocytoma, Hypoglycaemia, Asthma, Arrythmia
After taking a careful history over the 6 months, with the patient, you consider the possibility of a diagnosis of Generalised Anxiety Disorder (GAD).
4. What differentiates GAD from other anxiety disorders?
In GAD the symptoms occur persistency rather than under particular circumstances
The patient is interested in Cognitive Behavioural Therapy (CBT) to help manage her symptoms.
5. Give three examples of “thought errors” that are commonly identified through CBT (3)
Catastrophizing, Black and White/All or Nothing Thinking, Perfectionism, Unrealistic Beliefs, Cognitive Distortion
- Give three examples of other treatment options for GAD
Counselling, Relaxation Training, Medication eg SSRI, Beta Blockers
You are the Foundation Doctor Year 2 in the Accident and Emergency Department of a busy hospital. A 20 year old man has been brought by the Police having been arrested following a disturbance in the centre of the town. He appears disorientated and is talking about flying robots attacking the city and that he has to scale a church steeple in order to stop this. He is alert and orientated.
- What initial steps are required in assessing his condition? (3)
Take a History, Obtain Previous Records, General Exam including Neuro, Basic NEWS Recording
You are the Foundation Doctor Year 2 in the Accident and Emergency Department of a busy hospital. A 20 year old man has been brought by the Police having been arrested following a disturbance in the centre of the town. He appears disorientated and is talking about flying robots attacking the city and that he has to scale a church steeple in order to stop this. He is alert and orientated.
- Which investigations would you consider undertaking?
Urine or other Drug Screen, CT Head, Bloods: FBC, U+E, LFT, CRP, TFT
You are the Foundation Doctor Year 2 in the Accident and Emergency Department of a busy hospital. A 20 year old man has been brought by the Police having been arrested following a disturbance in the centre of the town. He appears disorientated and is talking about flying robots attacking the city and that he has to scale a church steeple in order to stop this. He is alert and orientated.
- What one investigation is most likely to be helpful in establishing the diagnosis? (1)
Urine or other drug screen
All of the investigations you have ordered have been negative. You therefore decide to refer him to psychiatry. You have established that the patient believes with no doubt that flying robots are going to attack the city if he does not intervene although he has never seen them.
- How is the patient’s belief about flying robots best described?
Delusions
The patient is refusing to consent to remain in the department and tries to leave. The security staff have been called and are stopping him from leaving. He intends to climb to a high place immediately and to fight with anyone who stops him.
- What piece of legislation could be considered to prevent him leaving the hospital? (1)
Mental Health Care and Treatment Scotland Act 2003. It would not be appropriate to use Adults with Incapacity Act 2000 at he is being actively prevented from leaving
- Which section would be most likely used in the emergency department? (1)
Emergency Detention Certificate
- Which section would be most likely used in the emergency department? (1)
Emergency Detention Certificate - Would you, as the FY2, be able to apply this legislation (1) and why (1)?
Yes. An emergency detention certificate can be applied by any fully registered medical practitioner usually with consent of mental health officer
A young boy presents with their mother, who is concerned about some behaviours her son has been exhibiting in the last few months. She describes her son as taking a very long time to get ready for school as he is repetitively checking light switches and so has gotten in trouble at school due to being late repeatedly. Based on the most likely diagnosis, what is the most appropriate initial treatment?
- CBT
- Exposure and response training
- Family therapy
- Clomipramine
- Selective serotonin reuptake inhibitors (SSRIs)
- Exposure and response training
