Med Student Finals Category: Psychiatry

MSFinals-5633

A 47-year-old woman presents complaining of ‘flashbacks’. Seven months earlier, she had been standing at a bus stop when a car swerved off the road into the queue, killing instantly a child standing near to her. Every day she experiences intrusive images of the child’s face as it saw the car mount the curb. She has not been able to go to that part of town since the day and she has avoided taking the bus anywhere. She feels she is always on edge and jumps at the slightest noise around the house. She thinks things are getting worse, rather than better, and asks you whether there are any psychological treatments that might help her.
Which one of the following approaches is indicated?

MSFinals-5602

A 39-year-old man, with a history of severe depression, is admitted unconscious to the hospital, following a suicide attempt where he stabbed himself with a knife, with significant intent of causing death. His past psychiatric history suggests that this is his fifth suicide attempt, with the four previous attempts involving taking an overdose of his antidepressants and paracetamol. During this admission, he needed surgery for bowel repair. He is now three days post-operation on the Surgical Ward and is having one-to-one nursing due to recurrent suicidal thoughts after his surgery. The consulting surgeon thinks he is not fit enough to be discharged, and a referral is made to liaison psychiatry. After assessing the patient, the psychiatrist reports that the patient’s current severe depression is affecting his capacity and that the patient’s mental health puts himself at risk of harm. The psychiatrist decides to detain him on the ward for at least three days. The patient insists on leaving and maintains that he has no interest to be alive.
Which is the most appropriate section for the doctor to use to keep this patient in hospital?

MSFinals-5603

A 75-year-old woman is admitted to a medical ward and the medical team is concerned about her mental health in addition to her urgent medical needs. The patient is refusing treatment and insisting on leaving. The team suspects that she may be mentally incapacitated and unable to make an informed decision. Under which section of the Mental Health Act (MHA) can they legally detain her in England and Wales?

MSFinals-5604

According to the Mental Health Act (1983), which section should be used to detain a teenage patient, already in hospital, who is suffering from acute psychosis and is attempting to leave the hospital against medical advice?

MSFinals-5605

An 81-year-old man is transferred from a nursing home with a change in behaviour, insomnia and fever. Staff in the nursing home state that over the last five days, he has appeared confused and agitated and seems to be having visual hallucinations, as he has been talking and gesturing to people who are not present in the room. He has a past medical history of Lewy body dementia. On clinical examination, he is not orientated to time, place or person. He is mildly agitated. His blood pressure is 112/60 mmHg, pulse 96 bpm and temperature 38.2 °C. Urinalysis is positive for nitrites and leukocytes.
Which of the following management plans should be considered as initial treatment for delirium?

MSFinals-5606

Venlafaxine is an antidepressant that is commonly prescribed for the treatment of major depression, anxiety, and panic disorder. What is the most accurate description of the mechanism of action of this medication?

MSFinals-5607

A 30-year-old man visits his doctor six weeks after being diagnosed with generalised anxiety disorder (GAD). Despite undergoing cognitive behavioural therapy for a few sessions, his symptoms continue to significantly impact his daily routine. He inquires about the possibility of taking medication for his anxiety.
What is the primary drug class used to treat GAD?

MSFinals-5608

A 25-year-old man with type I diabetes mellitus visits his General Practitioner (GP) with concerns about his deteriorating glycaemic control. The GP suspects poor compliance with diet and medication. What is the most effective approach to enhance his compliance during a brief consultation?

MSFinals-5609

A 67-year-old man is prescribed duloxetine for a major depressive episode after having no response to citalopram or fluoxetine.

What is the mechanism of action of the newly added drug?

MSFinals-5610

You are discussing bipolar disorder with your consultant in a geriatric trainees teaching session as part of your psychiatry attachment.
Which of the following is the most common medical treatment in the long-term management of bipolar disorder in older adults?