SpecIalties - Psych

Question 1

List the 7 criteria for alcohol dependence in the ICD10

Answer 1

Compulsion
Lack of control
Physical withdrawal
Tolerance
Neglect of other interests or pleasures, with increased time invested in obtaining, taking, or recovering from alcohol
Persistent abuse despite understanding the harmful consequences manifesting

Question 2

What are the 3 core symptoms of depression?

Answer 2

Anhedonia
Anergia
Low mood (classic diurnal variation- feel worse in morning)

Question 3

Management depression

Answer 3

x

Question 4

define a hallucination

Answer 4

absent stimulus

Question 5

Schizophrenia risk factors

Answer 5

obstetric complications
genetics
month of birth - winter viral
substance misuse - potential red herring as precipitates does not cause
Urban, low social class
adverse life event
close contact w highly critical relatives

Question 6

Diagnosis

Answer 6

negative symptoms of schizophrenia

Question 7

organic illness causing catatonia

Answer 7

x

Question 8

A 68 year-old man is referred to memory services after his daughter took him to see the GP with concerns about his memory over the previous 4 weeks. You note that prior to this decline, he was admitted to ITU for a week with a severe pneumonia which progressed to sepsis. Your assessment of him reveals some cognitive impairment and disorientation in time but not place.

What is the most appropriate next step?

A. Refer him for an urgent MRI head
B. Ask the GP to reassess him in a few weeks
C. Take blood cultures and a urine dipstick
D. Refer to a dementia specialist and contact OT to assess the home
E. Perform a chest x-ray

Answer 8

B. Ask the GP to reassess him in a few weeks

The cognitive impairment described here is a result of delirium. Delirium refers to a fluctuating state of confusion which comes on quickly and can be the result of drugs, trauma, infection, electrolyte imbalance, or a number of other causes. Though the onset is rapid, delirium can take a long time to fully resolve, with some patients still displaying symptoms at 6 months post-discharge.

Accordingly, memory services will not assess a patient if they have had an episode of delirium within the last 6 weeks as the residual effects will obfuscate the results of the assessment.

Assessments for cognitive impairment should take place at least 6 weeks after an

Question 9

symptoms after dosage change

Answer 9

neuroleptic malignant syndrome

Question 10

extrapyramidal side effects

Answer 10

x

Question 11

Which of the following is the best way to respond to a delusional patient asking if you believe them

Answer 11

p83 Psych PRN

Question 12

Which of the following statements is true?

A. A section 136 can be used to enter a person’s home against their wishes
B. Once a patient is taken to a place of safety, they can’t be moved from that place of safety
C. A section 5(2) cannot be used in A&E
D. A nurse has the power to hold a patient for 24 hours under section 5(4)
E. A section 2’s primary function is to allow treatment of a detained patient

Answer 12

C. A section 5(2) cannot be used in A&E

Question 13

Who must be present for a Section 135 to be enacted?

Answer 13

An AMP
A registered medical practitioner
A police constable

Question 14

Which of the following sections gives a doctor the power to detain a person under the Mental Health Act for 72 hours for assessment if they have already been admitted to hospital?

A. Section 2
B. Section 5(2)
C. Section 135
D. Section 5(4)
E. Section 12

Answer 14

B. Section 5.2

Question 15

List the ICD10 non-core symptoms of depression

Answer 15

Reduced concentration and attention
Reduced self-esteem and self-confidence
Ideas of guilt and unworthiness (even in a mild type of episode)
Bleak and pessimistic views of the future
Ideas or acts of self-harm or suicide
Disturbed sleep
Diminished appetite

Mild: At least 2 core plus at least 2 other symptoms, should not be intense
Moderate: At least 2 core plus at least 3 other symptoms, preferably 4 for moderate
Severe: All 3 core plus at least 4 other symptoms, somatic syndrome (physical manifestations) almost definitely present
Severe with psychosis: as for severe depression with the added presence of delusions, hallucinations, or depressive stupor

Question 16

You visit the home of a 45 year-old man being treated in the community for his schizophrenia. He was diagnosed 25 years ago and has been mostly well managed, but is now beginning to disengage from psychiatric services. When talking to him you notice his pattern of thought seems disordered, and he occasionally seems to react to sounds or sights that you do not perceive. He also grimaces, and makes rhythmic sucking movements with his mouth in a way that seems unrelated to the conversation.

What is the most likely explanation for the grimacing and sucking movements?

A. Tetany
B. Parkinsonism
C. A reaction to hallucinations
D. Acute dystonia
E. Tardive dyskinesia

Answer 16

E. Tardive dyskinesia

Question 17

You are called to see a 72 year-old patient who was noted to be distressed and disorientated on the ward yesterday. She seemed mentally well when she was admitted, but over the next few hours became confused and agitated, and spoke fearfully of the creatures she saw scurrying about on the floor, which the nursing staff could not see. The nurses reported her speech and though patterns seemed disordered. When you see her she seems calm and reasonable, without much memory of her episode last night.

What is the most likely cause of her symptoms?

A. Vascular dementia
B. Alzheimer's disease
C. Delirium
D. Lewy body dementia
E. Parkinson's disease

Answer 17

C. Delirium

Question 18

A 56 year old woman has been hospitalised for myocardial infarction. 2 nights after admission, she screams that there is a man sitting by her bed. When the light is turned on, she is relieved that ’the man’ is actually a chair with clothes draped over it.

What misperception best describes this?

A. Delusion
B. Hallucination
C. Illusion
D. Projection
E. Formication

Answer 18

C. Illusion

Question 19

You are asked to assess a 63 year-old man with Parkinson’s. He seems to be low in mood. When you speak with him, he seems to understand all your questions and answers appropriately, but he appears to have difficulty getting his words out.

Which of the following speech disorders does this describe?

A. Dysphasia
B. Bradykinesia
C. Poverty of speech
D. Dysarthria
E. Loosening of association

Answer 19

D. Dysarthria

Question 20

pseudodementia

Answer 20

x

Question 21

Which of the following is true of anti-psychotic drugs?

A. Involuntary painful muscle spasms may occur within hours of starting anti-psychotics
B. Haloperidol is a safe alternative for use in patients at risk of arrhythmia
C. There are no atypical anti-psychotics available as depot injections
D. Neuroleptic malignant syndrome is usually triggered by suddenly decreasing anti-psychotic dose/ sudden non-compliance
E. Typical anti-psychotics usually cause less severe extra-pyramidal side effects

Answer 21

A. Involuntary painful muscle spasms may occur within hours of starting anti-psychotics

Question 22

Match the section with the description

Answer 22

x