Med Student Finals Category: Psychiatry

MSFinals-5637

Which of the following factors does not contribute to a higher likelihood of developing schizophrenia or a similar psychotic disorder?

MSFinals-5638

An 87-year-old man who lives in a care home is reported missing after breakfast. The care home actively tries to find him but is not able to for the next few hours. A police report is made, and later that day, the man is found wandering two streets away from the care home. He is brought back to the care home, and the care home is concerned that he might try to get out again. The nurse caring for the patient reports that the man has been trying to get out of the care home for the past few weeks but did not manage to do so, as they were able to prevent him on time. The care home wants to fit a lock to the patient’s room door to restrict his mobility during busy times of the day when limited staff are available to make sure he does not get out. The patient is medically stable, has a diagnosis of dementia, and is known to lack capacity to make a decision about his treatment and freedom.
Which of the following is the best course of action for this patient?

MSFinals-5639

A 84-year-old woman is admitted to the hospital after falling outside her home. Her carers, who visit three times a day, report that the patient becomes aggressive when prevented from going outside and she also refuses to be accompanied. The patient has no next-of-kin, and she was formally diagnosed with dementia last year. She has a past medical history of hypertension. She is now medically fit for discharge from hospital, but she lacks capacity to make a decision regarding her treatment and her place of residence. It is proposed that an application is made under the Deprivation of Liberty Safeguards (DoLS), in her best interests, to prevent the patient from wandering outside. The ward manager says that this cannot be done, as the patient does not meet all the criteria.

Which of the following is preventing a DoLS from being authorised for this patient?

MSFinals-5640

A 40-year-old woman has been seen by her general practitioner (GP) with symptoms of moderate anxiety, including frequent panic attacks, feeling very tired all the time, poor appetite and a short temper. She is taking time off work, arguing with her family and friends and becoming increasingly isolated as a result of the symptoms. She has tried cognitive behavioural therapy but found no benefit. She would like to try medication, and the GP has agreed to start citalopram.
What advice should she be given before starting the medication?

MSFinals-5641

A 36-year-old man with a known history of severe depression has been in hospital for the past year. He was diagnosed with depression at the age of 23 and has been on antidepressants since. He has had multiple self-harm and suicide attempts in the past. For the past year, he has been receiving treatment in hospital and has been making some progress with regard to his mental health. He is not happy to be in hospital, but the doctors thought that it was in his best interests to keep him in hospital for treatment. He has been under a Section which allowed him to be kept in hospital for six months. At the end of the first six months, the doctors applied for a second time for him to be kept for another six months, as they feel he is not yet fit for discharge.
For how long can the relevant Section be renewed for this patient for the third time?

MSFinals-5642

A 32-year-old woman with schizophrenia has been under the care of mental health services for a few years with a fluctuating pattern of illness. Her consultant, in collaboration with the patient’s Community Psychiatric Nurse (CPN), decides to initiate clozapine treatment. As a component of the prescription, she is registered into the Clozapine Monitoring Service scheme.
What is the primary rationale for her registration?

MSFinals-5643

A 32-year-old female is initiated on haloperidol for treatment-resistant schizophrenia. She visits her primary care physician with a complaint of neck pain and limited neck movement for the past 24 hours. Upon examination, she displays normal vital signs except for a mild tachycardia of 105 and neck stiffness with restricted range of motion. Her neck is involuntarily flexed towards the right. Her facial movements are normal. What is the probable diagnosis?

MSFinals-5644

A 45-year-old woman who is currently an informal inpatient at a mental health hospital is being evaluated for electroconvulsive therapy (ECT), a treatment she has never undergone before. What is an appropriate indication for ECT?

MSFinals-5645

A 32-year-old woman presents to her GP with a complaint of severe dyspareunia and loss of libido that has been ongoing for the past year. She has already been evaluated by a gynaecologist and discharged as all her tests were normal. She has undergone a pelvic ultrasound, laparoscopy, and blood tests for LH/FSH and TFTs, as well as low vaginal and endocervical swabs. She reports no symptoms of depression or anxiety and maintains a healthy lifestyle with regular exercise, good sleep, and a balanced diet. She denies any substance abuse. What is the most appropriate course of action?

MSFinals-5646

A 38-year-old woman and her 14-year-old daughter are apprehended after being caught trying to destroy a statue in the town square. When asked why, they both explain how the statue comes to life and terrorizes them at night, breaking things in their house, whispering violent thoughts in their minds and urging them to kill themselves. The police officer brings them to the Emergency Department where you evaluate them. The mother is a well-known psychiatric patient, but the daughter has never been seen before.
Which of the following is most likely to acutely reverse the psychosis in at least one of the patients?