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
A young woman presents to her GP quite worried about the sensation of something in her throat. She also complains of tiredness as she is struggling to sleep, tremors, feels she can sweat profusely when stressed, having a poor appetite and feeling nauseous. She strikes you as quite anxious about these symptoms, especially as she has some exams coming up. What would be the next best step for this patient?
A. Urgent referral for UGIE B. Refer to haematology C. Prescribe diazepam D. Reassure patient and advise some lifestyle changes E. Prescribe amitriptylline
D. Reassure patient and advise some lifestyle changes
You are concerned about your sibling who is extremely fearful of attending the doctors, and often experiences panic attacks when at the doctors, resulting in them missing many of their review appointments for their long-term conditions and routine screening appointments despite their conditions being well controlled and there being no medical concerns. You suspect they might have developed a phobia to the doctors. Select from those shown below what psychological treatments could be offered to help those who suffer from phobic disorders.
A. CBT B. Family therapy C. Exposure and response training D. Eye movement desensitization and reprocessing E. ECT
A. CBT
C. Exposure and response training
A patient attends complaining of feeling very anxious all the time, and describes other symptoms such as tremor, palpitations and sweating profusely. What blood test should also be carried out before diagnosing GAD to exclude another important differential diagnosis?
A. TFTs B. LFTs C. Toxic screen D. Glucose E. ABG
A. TFTs
A patient is diagnosed with obsessive compulsive disorder. They are known to be very inflexible in their work and their routine, which has caused some issues with their loved ones and colleagues. Which of the following is the 1st line treatment for mild obsessive compulsive disorder?
A. Short terms SSRIs B. Cognitive behavioural therapy C. Exposure response prevention therapy D. Eye movement desensitization and reprocessing E. Interpersonal therapy
C. Exposure response prevention therapy
A 13-year-old female presents with her parents due to concern regarding their recurrent panic attacks and nightmares that on questioning seem to be related to attending school, even after moving schools after being very badly bullied in her last school. When asked about the bullying she gets very tearful and refuses to talk about it. For the last few years, the parents have noticed she has become more withdrawn and doesn’t hang out with her old friends anymore. What is the most likely diagnosis?
A. Panic disorder B. Post traumatic stress disorder C. Autism spectrum disorder D. Stress reaction E. Depression
B. Post traumatic stress disorder
You see a patient recently diagnosed with Post Traumatic Stress Disorder (PTSD). Which of the following is not a recommended treatment for PTSD?
A. Immediate debriefing following a traumatic event
B. Cognitive behavioural therapy
C. SSRIs e.g. paroxetine
D. Antipsychotics
E. Eye movement desensitization and reprocessing (EMDR
D. Antipsychotics
Who can complete a Certificate of Incapacity form?
Tick all that apply
GP Consultant pyschiatrist FY1 Registered nurse Dental practitioner Family member Optician Next of kin
GP Consultant pyschiatrist Registered nurse Dental practitioner Optician
Emergency Detention Certificate detention up to?
72 Hours
Short Term Detention Certificate up to?
28 Days
Compulsory Treatment Order up to?
6 Months
Nurse’s holding power up to?
3 hours
Which legal document is used in Scotland when assessing if an individual has capacity?
A. Mental Capacity Act (2005)
B. Adults with Incapacity (Scotland) Act 2000
C. Mental Health Act 2007
D. Mental Health (Care and Treatment) (Scotland) Act 2003
E. Adult Support and Protection (Scotland) Act 2007
B. Adults with Incapacity (Scotland) Act 2000
The power from which legal document is needed if you think a patients mobile phone may need to be confiscated as they are putting themselves or ward staff at risk, or it has a detrimental effect on their care?
A. Specified person B. Named person C. Power of Attorney D. Guardianship order E. Restriction order
A. Specified person
Select which of the following are powers available to the Police
A. Removal from a public place
B. Removal from their home address
C. Detention for up to 24 hours
D. Compulsory medical treatment against patients wishes
E. Transfer patients to places of safety
F. Transfer patients for assessment and treatment
E. Transfer patients to places of safety
Which act would be used to determine if an individual had diminished responsibility due to their mental health?
A. Mental Health Act 2007
B. Adults with Incapacity (Scotland) Act 2000
C. Adult Support and Protection (Scotland) Act 2007
D. Criminal Justice and Licensing (Scotland) Act 2010
E. Criminal Procedure (Scotland) Act 1995
D. Criminal Justice and Licensing (Scotland) Act 2010
Which of the following are the 5 necessary factors when assessing if a treatment order is necessary?
A. Mental disorder is likely B. Poor compliance with treatment C. Treatment available D. Refusal of treatment by patient E. Risk to patient or others F. Suitable bed available G. Hospitalisation is necessary
A. Mental disorder is likely C. Treatment available E. Risk to patient or others F. Suitable bed available G. Hospitalisation is necessary
A man presents complaining of poor mood and loneliness. On questioning, you find he has been withdrawing from friends and family as he is worried about not being liked enough or criticized. He feels like he has been this way all of his life, though just might be getting a bit worse. What is this a typical history of?
A. Avoidant personality disorder
B. Social phobia
C. Depression
D. Generalised anxiety disorder
A. Avoidant personality disorder
A young woman presents to A+E with fresh self harm wounds. She tells you she had had a fight with her girlfriend as she doesn’t believe she can trust her and knows she must be cheating on her. She felt overwhelmed, and as she has fallen out with most of her friends, she didn’t know what else to do. Which of the following disorders could be the most likely diagnosis?
A. Dependent personality disorder B. Paranoid personality disorder C. Depression D. Schizophrenia E. Emotionally unstable personality disorder
E. Emotionally unstable personality disorder
A mother presents worried about her son. He is 26 years old and from a young age hasn’t shown any interest in forming any social relationships, and has been found to be quite cold and secretive by others. He prefers to be alone and all of his hobbies are solitary, with his favourite hobby being fantasy gaming and books. She notes he has always had a “wild sense of imagination”. What could be the underlying diagnosis?
A. Schizoid personality disorder B. Schizotypal personality disorder C. Avoidant personality disorder D. Schizophrenia E. Social phobia
A. Schizoid personality disorder
A man presents to their GP with odd beliefs dressed in unusual attire. He is well known locally for his wild beliefs despite being quite reserved and not wanting to interact with others, and when caught up in conversations often talks to himself or displays peculiar speech mannerisms. They tell you that they feel very anxious in social settings due to often interpreting social interactions as odd or unusual. What disorder is this patient most likely to have?
A. Mania B. Schizoid personality disorder C. Schizotypal personality disorder D. Anxiety E. Depression with psychosis
C. Schizotypal personality disorder
A man presents to his GP, and during the appointment acts quite inappropriately towards the GP by trying to make sexual advancements. When you try and shut down this behavior and end the consultation, he becomes annoyed at the lack of attention. You hear from the other GPs that have known him for most of his life that this is a common occurrence, even with individuals within the community.
What could be the diagnosis for this patient?
A. Antisocial personality disorder
B. Narcissistic personality disorder
C. Histrionic personality disorder
D. Emotionally unstable personality disorder
C. Histrionic personality disorder
A young man, who is well known to A+E and the police due to regular fights and getting into trouble all through their adolescence, has presented again to A+E after another fight. He again refuses to take any responsibility and shows no remorse for the innocent bystander he attacked. He has been caught multiple times trying to sneak away or lying about his actions. What is the most likely diagnosis?
A. Antisocial personality disorder
B. Conduct disorder(?)
C. Narcissistic personality disorder
D. Avoidant personality disorder
A. Antisocial personality disorder
Another consultant you work with has created a bit of a reputation on the ward. She is known to be very preoccupied with success and displays a high degree of self importance, and comes across as quite arrogant, cold and having a lack of empathy by your colleagues. What could be the likely cause?
A. Schizoid personality disorder B. Antisocial personality disorder C. Emotionally unstable personality disorder D. Schizotypal personality disorder E. Narcissistic personality disorder
E. Narcissistic personality disorde
Which of the following parameters is not monitored annually after the patient is on an established dose of clozapine?
A. Weight B. Blood lipids C. FBC D. Fasting blood glucose E. Prolactin
C. FBC
Which of the following is not an important side effect of typical anti-psychotics such as chlorpromazine?
A. Extrapyramidal side effects (EPSEs) B. Weight gain C. Neuroleptic malignant syndrome D. Hyperprolactinaemia E. Prolonged QT interval
B. Weight gain
What treatment is offered to those who have had an overdose on benzodiazepines?
A. Adenosine B. Activated charcoal C. Acetylcysteine D. Naloxone E. Flumazenil
Flumazenil
Select any of the following that can be used in the treatment of opioid dependence
A. Sublingual buprenorphine B. Oral methadone C. IM Naloxone D. IV Flumazenil E. Sublingual buprenorphine with naloxone
A. Sublingual buprenorphine
B. Oral methadone
E. Sublingual buprenorphine with naloxone
What is the mechanism of action of risperidone?
A. Prevents the breakdown of acetylcholinesterase
B. Antagonise NMDA receptor sites
C. D2 receptor antagonist
D. Enhance the binding of GABA to GABAA receptors
E. Inhibit serotonin reuptake
C. D2 receptor antagonist
Which of the following is the most appropriate first line medication for the treatment of GAD?
A. Propranolol B. Diazepam C. Imipramine D. Sertraline E. Quetiapine
D. Sertraline
A patient is brought to A&E with a suspected overdose from a popular nightclub in the early hours of the morning. On examination, the patient is hyperthermic, hyperreflexic, have muscle rigidity and dilated pupils. What is the most likely substance that the patient has overdosed on?
A. Heroin B. Cocaine C. Ecstasy D. Cannabis E. Ketamine
C. Ecstasy
A patient in ED is suspected to have overdosed on TCAs. Which ECG changes would be seen? Tick all that apply
A. Long QT B. Short QT C. Wide QRS D. Narrow QRS E. Tachycardia F. Bradycardia
A. Long QTC.
C. Wide QRSE. E. Tachycardia
Mrs P, a 49-year-old woman, has been brought to her GP by her husband who is worried about her drinking. In the consultation she admits that over the last 3 months she has dropped many of her usual hobbies due to drinking, feels she needs to drink more than she used to to get the same effect and feels strong compulsions to drink, even after some accidents that have happened while intoxicated. How likely is it that she has alcohol dependence?
a. None – normal drinking pattern
b. Harmful use of alcohol
c. Mild possibility of dependence
d. Diagnostic threshold met for alcohol dependence
e. Unsure - further questioning required
d. Diagnostic threshold met for alcohol dependence
What is the recommended maximum units of alcohol men and women can drink in one week?
14 Units per week
Which of the following alcohol screening tests is the most accurate when screening pregnant woman?
A. CAGE B. AUDIT C. FAST D. PAT E. TWEAK
E. TWEAK
Which of the following is a classic physical sign of alcohol misuse you may find on examination?
A. Koilonychia B. Xanthelasma C. Asterixis D. Malar flush E. Stenosing tenosynivitis
C. Asterixis
To calculate the number of units in a bottle, you need to multiply the number of millilitres by the ABV and then divide this by 1000 [INSERT EQUATION].
A bottle of wine (alcohol percentage = 12%) contains 750ml. How many units are found in the bottle?
9 units
9 units
13 months later, Mrs P presents again with her husband. She has had a rough couple of months following being fired from her job and admits to drinking again and has stopped taking her medication for alcohol cessation . On examination you notice she has some physical findings such as nystagmus and ataxia, and during the history you notice she seems quite confused, with her husband adding she has become noticeably more confused in the last few weeks. According to these findings, what do you think is the most pressing management to be organized immediately?
A. Organise inpatient care for acute alcohol withdrawal
B. Restart original treatment and review in 3-4 weeks
C. Urgent thiamine replacement
D. Memory test
E. Watch and wait – see again in 2 weeks
C. Urgent thiamine replacement
