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Question 1
Incorrect
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You are obtaining a medical history from a frequent visitor to the emergency department, who has a history of alcoholism. He arrived at the department feeling unwell last night. He informs you that he has recently returned from a trip to Hawaii, where he spent the last three weeks. He appears restless as he expresses his desire to go on another vacation tomorrow. However, you recall admitting him to the emergency department just a week ago.
What is your suspicion regarding his motive for sharing this falsehood?Your Answer: It's a feature of his wernicke encephalopathy
Correct Answer: He has an underlying thiamine deficiency
Explanation:Korsakoff’s syndrome is caused by untreated thiamine deficiency, which is also the underlying reason for Wernicke-korsakoff syndrome. Wernicke encephalopathy is an acute neurological deterioration due to thiamine deficiency, while Korsakoff’s syndrome is a chronic neurological deterioration characterized by deficits in memory and confabulation. In this case, the patient’s confabulation is likely due to retrograde memory impairment, which is a feature of Korsakoff’s syndrome. The patient’s history of alcoholism suggests a thiamine deficiency, which can lead to Wernicke-korsakoff syndrome. While alcohol withdrawal is a possible differential, it alone cannot explain the patient’s confabulation. It is important to exclude organic causes before assuming the patient is actively lying.
Understanding Korsakoff’s Syndrome
Korsakoff’s syndrome is a memory disorder that is commonly observed in individuals who have a history of alcoholism. This condition is caused by a deficiency in thiamine, which leads to damage and haemorrhage in the mammillary bodies of the hypothalamus and the medial thalamus. Korsakoff’s syndrome often follows untreated Wernicke’s encephalopathy, which is another condition caused by thiamine deficiency.
The primary features of Korsakoff’s syndrome include anterograde amnesia, which is the inability to acquire new memories, and retrograde amnesia. Individuals with this condition may also experience confabulation, which is the production of fabricated or distorted memories to fill gaps in their recollection.
Understanding Korsakoff’s syndrome is crucial for individuals who have a history of alcoholism or thiamine deficiency. Early diagnosis and treatment can help prevent further damage and improve the individual’s quality of life. Proper nutrition and abstinence from alcohol are essential for managing this condition.
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This question is part of the following fields:
- Psychiatry
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Question 2
Correct
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A 60-year-old male patient comes in for a routine colonoscopy. He had stage I colon cancer that was treated successfully ten years ago. During the discussion of his thoughts, concerns, and expectations, he mentions that he hasn't thought about the potential results until now and that worrying won't change anything.
What ego defense mechanism is he displaying?Your Answer: Suppression
Explanation:Understanding Ego Defenses
Ego defenses are psychological mechanisms that individuals use to protect themselves from unpleasant emotions or thoughts. These defenses are classified into four levels, each with its own set of defense mechanisms. The first level, psychotic defenses, is considered pathological as it distorts reality to avoid dealing with it. The second level, immature defenses, includes projection, acting out, and projective identification. The third level, neurotic defenses, has short-term benefits but can lead to problems in the long run. These defenses include repression, rationalization, and regression. The fourth and most advanced level, mature defenses, includes altruism, sublimation, and humor.
Despite the usefulness of understanding ego defenses, their classification and definitions can be inconsistent and frustrating to learn for exams. It is important to note that these defenses are not necessarily good or bad, but rather a natural part of human behavior. By recognizing and understanding our own ego defenses, we can better manage our emotions and thoughts in a healthy way.
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This question is part of the following fields:
- Psychiatry
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Question 3
Incorrect
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A middle-aged male patient with a history of schizophrenia and non-compliance with medication presents with delusions of alien possession. How would you characterize his delusions?
Your Answer: Nihilistic delusions
Correct Answer: Delusions of control
Explanation:Schizophrenia Symptoms: Delusion of Control, Depersonalisation, and Delusions of Misidentification
Delusion of control, also known as passivity experience, is a primary symptom of schizophrenia identified by Schneider. This symptom is characterized by the belief that one’s body, mind, volition, or emotion is being controlled by another entity, being, or force. On the other hand, depersonalisation is the feeling of being disconnected from reality, often accompanied by derealisation.
Delusions of misidentification, another symptom of schizophrenia, can be divided into two types: Fregoli Syndrome and Capgras Syndrome. Fregoli Syndrome is the belief that someone whose appearance is unfamiliar is actually someone you know, while Capgras Syndrome is the belief that someone who looks familiar is an imposter.
Overall, these symptoms can significantly impact an individual’s perception of reality and their ability to function in daily life. It is important to seek professional help if experiencing any of these symptoms or suspecting someone else may be experiencing them.
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This question is part of the following fields:
- Psychiatry
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Question 4
Incorrect
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What is the term used to describe the recurring thoughts of harming one's own family, even though the person does not want to act on them?
Your Answer: Compulsions
Correct Answer: Obsessional thoughts
Explanation:Possession of Thought
Possession of thought can be understood through the concepts of ego-syntonicity and ego-dystonicity. Ego-syntonic experiences are consistent with an individual’s self-image, while ego-dystonic experiences are not. Obsessional thoughts are unwanted and distressing thoughts, ideas, or images that are recognized as the individual’s own, making them ego-dystonic.
Thought broadcast is a passivity experience where the individual believes their thoughts are taken away from their head and widely broadcast. On the other hand, thought insertion is a phenomenon where the individual believes that their thoughts have been placed inside their head from outside. Both thought broadcasting and insertion are thought alienation experiences and are first rank symptoms of schizophrenia.
In the case of thought alienation experiences, the division between ego-syntonicity and ego-dystonicity is less clear. Although initially ego-syntonic, as the individual recovers from psychosis, they may recognize thought alienation experiences as more distressing and therefore more ego-dystonic in nature.
Compulsions are obsessional motor acts that the patient recognizes as unnecessary but cannot resist performing. possession of thought and its various experiences can aid in the diagnosis and treatment of mental health disorders.
Overall, possession of thought is a complex phenomenon that can have significant impacts on an individual’s mental health and well-being. By the different experiences and their relationship to ego-syntonicity and ego-dystonicity, mental health professionals can provide more effective treatment and support to those experiencing these symptoms.
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This question is part of the following fields:
- Psychiatry
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Question 5
Correct
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A 28-year-old man with schizophrenia who began taking clozapine 2 weeks ago visits for his routine blood test. What is a known severe side effect of clozapine?
Your Answer: Agranulocytosis
Explanation:Clozapine, an antipsychotic medication used to treat refractory schizophrenia, requires continuous monitoring for patients taking it. This involves weekly blood tests for the first 18 weeks, followed by bi-weekly tests until the first year, and then monthly tests thereafter.
Atypical antipsychotics are now recommended as the first-line treatment for patients with schizophrenia, as per the 2005 NICE guidelines. These agents have a significant advantage over traditional antipsychotics in that they cause fewer extrapyramidal side-effects. However, atypical antipsychotics can still cause adverse effects such as weight gain, hyperprolactinaemia, and clozapine-associated agranulocytosis. Elderly patients who take antipsychotics are at an increased risk of stroke and venous thromboembolism, according to the Medicines and Healthcare products Regulatory Agency.
Clozapine is one of the first atypical antipsychotics to be developed, but it carries a significant risk of agranulocytosis. Therefore, full blood count monitoring is essential during treatment. Clozapine should only be used in patients who are resistant to other antipsychotic medication. The BNF recommends introducing clozapine if schizophrenia is not controlled despite the sequential use of two or more antipsychotic drugs, one of which should be a second-generation antipsychotic drug, each for at least 6-8 weeks. Clozapine can cause adverse effects such as reduced seizure threshold, constipation, myocarditis, and hypersalivation. Dose adjustment of clozapine may be necessary if smoking is started or stopped during treatment.
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This question is part of the following fields:
- Psychiatry
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Question 6
Incorrect
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Samantha is undergoing an evaluation with the psychologist. Her sister has joined the session to provide her with moral support. With Samantha's consent, the psychologist is inquiring her sister about her personality.
Samantha's sister characterizes her to the psychologist as someone who appears to be lively, charming and sociable at first. However, as you spend more time with her, you come to realize that she is excessively theatrical, constantly seeking attention and admiration, and she can be quite manipulative.
What kind of personality disorder does Samantha have?Your Answer:
Correct Answer: Histrionic personality disorder
Explanation:Personality Disorders: General Criteria and Specific Types
Personality disorders are a group of mental health conditions that are characterised by deviations from the cultural norm in cognition, affect, impulse control, or relating to others. According to ICD-10, individuals diagnosed with a personality disorder must meet certain general criteria, including long-term evidence of the deviation since childhood or adolescence, distress to the individual or negative impact on their social environment, and the absence of an alternative mental disorder or organic brain injury.
There are several specific types of personality disorders, each with their own unique characteristics. Histrionic personality disorder is characterised by self-dramatisation, suggestibility, shallow affectivity, and a continual seeking for excitement and attention. Borderline personality disorder is associated with disturbances in self-image, intense relationships, emotional crises, and deliberate self-harm. Anankastic personality disorder is similar to obsessive-compulsive personality disorder, with individuals becoming preoccupied with detail, rules, and schedules to the point of hindering completion of tasks and relationships. Schizoid personality disorder is characterised by emotional detachment and solitary activities, while paranoid personality disorder involves high levels of suspicion and distrust towards others.
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This question is part of the following fields:
- Psychiatry
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Question 7
Incorrect
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A 35-year-old male patient is feeling impatient as he waits in a crowded Emergency Room (ER) waiting area. He snaps at his daughter in annoyance.
What ego defence mechanism is he utilizing?Your Answer:
Correct Answer: Displacement
Explanation:Understanding Ego Defenses
Ego defenses are psychological mechanisms that individuals use to protect themselves from unpleasant emotions or thoughts. These defenses are classified into four levels, each with its own set of defense mechanisms. The first level, psychotic defenses, is considered pathological as it distorts reality to avoid dealing with it. The second level, immature defenses, includes projection, acting out, and projective identification. The third level, neurotic defenses, has short-term benefits but can lead to problems in the long run. These defenses include repression, rationalization, and regression. The fourth and most advanced level, mature defenses, includes altruism, sublimation, and humor.
Despite the usefulness of understanding ego defenses, their classification and definitions can be inconsistent and frustrating to learn for exams. It is important to note that these defenses are not necessarily good or bad, but rather a natural part of human behavior. By recognizing and understanding our own ego defenses, we can better manage our emotions and thoughts in a healthy way.
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This question is part of the following fields:
- Psychiatry
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Question 8
Incorrect
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A 16-year-old girl is brought to her family doctor by her parents due to concerns about her weight and low mood. The parents are worried that their daughter has been excessively focused on her weight and has lost interest in her hobbies. The girl admits to exercising and watching her weight, but also reports feeling low for the past month and having trouble sleeping. The doctor measures her body mass index at 17.8 kg per m² and suggests prescribing an antidepressant to improve her mood. However, which of the following antidepressants is specifically contraindicated in this patient?
Your Answer:
Correct Answer: Bupropion
Explanation:The young girl in question appears to be suffering from anorexia nervosa, as she is overly concerned with her weight despite having a low body mass index. It is common for females of a young age to develop this condition, and it is often accompanied by depression, which can manifest as low mood, loss of interest in hobbies, and sleep disturbances.
One recommended antidepressant for patients with anorexia nervosa is mirtazapine, as it can also increase appetite and promote weight gain. Fluoxetine, a selective serotonin reuptake inhibitor, is not contraindicated for anorexia nervosa, but it can cause gastrointestinal distress or sexual dysfunction, which may make it difficult for young patients to comply with the medication. Amitriptyline, a tricyclic antidepressant, is typically used for major depression but has a worse side-effect profile than selective serotonin reuptake inhibitors. Bupropion, an atypical antidepressant commonly used for smoking cessation, is not recommended for patients with anorexia nervosa or bulimia nervosa, as it can lower the seizure threshold and increase the risk of seizures.
Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for depression, with citalopram and fluoxetine being the preferred options. They should be used with caution in children and adolescents, and patients should be monitored for increased anxiety and agitation. Gastrointestinal symptoms are the most common side-effect, and there is an increased risk of gastrointestinal bleeding. Citalopram and escitalopram are associated with dose-dependent QT interval prolongation and should not be used in certain patients. SSRIs have a higher propensity for drug interactions, and patients should be reviewed after 2 weeks of treatment. When stopping a SSRI, the dose should be gradually reduced over a 4 week period. Use of SSRIs during pregnancy should be weighed against the risks and benefits.
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This question is part of the following fields:
- Psychiatry
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Question 9
Incorrect
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After the passing of a dear friend, a 22-year-old male comes in with symptoms of confusion and auditory hallucinations. He appears to be in great distress and has developed a belief that he is a malevolent sorcerer. It is suspected that he may be experiencing brief psychotic disorder.
What are some characteristics of this disorder?Your Answer:
Correct Answer: It often results in a return to baseline functioning
Explanation:Brief psychotic disorder is a condition characterized by a sudden onset of psychotic symptoms, such as hallucinations or delusions, that typically occurs in response to a stressful event. Individuals with a pre-existing personality disorder may be more susceptible to this condition. However, the good news is that brief psychotic disorder often resolves within a month, and patients typically return to their normal level of functioning. This disorder is most commonly seen in individuals in their 20s, 30s, and 40s, and patients may not always be aware of the changes in their behavior.
Understanding Psychosis: Symptoms and Associated Features
Psychosis is a term used to describe a person’s experience of perceiving things differently from those around them. This can manifest in a variety of ways, including hallucinations, delusions, thought disorganization, alogia, tangentiality, clanging, and word salad. These symptoms can be associated with agitation, aggression, neurocognitive impairment, depression, and thoughts of self-harm.
Psychotic symptoms can occur in a number of conditions, including schizophrenia, depression, bipolar disorder, puerperal psychosis, brief psychotic disorder, neurological conditions like Parkinson’s disease and Huntington’s disease, and as a result of prescribed drugs or certain illicit drugs like cannabis and phencyclidine.
The peak age of first-episode psychosis is around 15-30 years. It is important to understand the symptoms and associated features of psychosis in order to recognize and seek appropriate treatment for those experiencing these symptoms.
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This question is part of the following fields:
- Psychiatry
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Question 10
Incorrect
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A 9-year-old child with ADHD is brought to the general practice by their mother for a check-up. The child has been taking methylphenidate for the past 2 years and the mother is concerned about their growth due to difficulties with eating. What is the mechanism of action of this medication?
Your Answer:
Correct Answer: Dopamine/norepinephrine reuptake inhibitor
Explanation:Benzodiazepines are a class of drugs that act as central nervous system depressants by enhancing the effects of the neurotransmitter gamma-aminobutyric acid (GABA). They are commonly used to treat anxiety, insomnia, and seizures.
In March 2018, NICE released new guidelines for the recognition and management of Attention Deficit Hyperactivity Disorder (ADHD). This condition can have a significant impact on a child’s life and can continue into adulthood, making accurate diagnosis and treatment crucial. ADHD is defined by DSM-V as a persistent condition that includes features of inattention and/or hyperactivity/impulsivity, with an element of developmental delay. The threshold for diagnosis is six features for children up to 16 years old and five features for those aged 17 or over. ADHD has a prevalence of 2.4% in the UK, with a possible genetic component and a higher incidence in boys than girls.
NICE recommends a holistic approach to treating ADHD that is not solely reliant on medication. After presentation, a ten-week observation period should follow to determine if symptoms change or resolve. If symptoms persist, referral to secondary care is necessary, usually to a paediatrician with a special interest in behavioural disorders or to the local Child and Adolescent Mental Health Service (CAMHS). A tailored plan of action should be developed, taking into account the patient’s needs and wants and how their condition affects their lives.
Drug therapy should be considered a last resort and is only available to those aged 5 years or older. For patients with mild/moderate symptoms, parents attending education and training programmes can be beneficial. For those who fail to respond or have severe symptoms, pharmacotherapy can be considered. Methylphenidate is the first-line treatment for children and should be given on a six-week trial basis. Lisdexamfetamine can be used if there is an inadequate response, and dexamfetamine can be started in those who have benefited from lisdexamfetamine but cannot tolerate its side effects. In adults, methylphenidate or lisdexamfetamine are first-line options, with switching between drugs if no benefit is seen after a trial of the other.
All of these drugs have the potential to be cardiotoxic, so a baseline ECG should be performed before starting treatment. Referral to a cardiologist is necessary if there is any significant past medical history or family history, or any doubt or ambiguity. A thorough history and clinical examination are essential for accurate diagnosis, given the overlap of ADHD with many other psychiatric and physical conditions.
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This question is part of the following fields:
- Psychiatry
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Question 11
Incorrect
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A slender 50-year-old man with a past of alcoholism arrives at the ER with ataxia, anterograde and retrograde amnesia, and ophthalmoplegia. According to his family member, he was previously treated for a comparable episode, but his memory has remained poor since then, and he appears to be fabricating false stories when testing his memory. The specialist suspects that he may be displaying symptoms of Korsakoff's syndrome.
What vitamin deficiency is responsible for causing this syndrome?Your Answer:
Correct Answer: Vitamin B1
Explanation:Korsakoff’s syndrome is primarily caused by a severe deficiency in thiamine (vitamin B1). Thiamine is essential for brain cells to produce energy, and without it, brain cells cannot function properly. This deficiency can lead to Wernicke’s encephalopathy, which, if left untreated, can progress to Korsakoff’s syndrome. Alcoholism is the most common cause of thiamine deficiency, but it can also be caused by other conditions such as anorexia nervosa, renal dialysis, and certain forms of cancer.
Deficiencies in vitamins B2, B3, B6, and B12 are not the primary cause of Korsakoff’s syndrome. Vitamin B2 deficiency can cause fatigue, angular stomatitis, and dermatitis. Mild vitamin B3 deficiency can cause similar symptoms to other vitamin B deficiencies, while severe deficiency can lead to pellagra. Vitamin B6 deficiency is rare and is usually associated with low levels of other B-complex vitamins. Vitamin B12 or folate deficiency can cause symptoms such as fatigue, anaemia, mouth ulcers, and shortness of breath.
Understanding Korsakoff’s Syndrome
Korsakoff’s syndrome is a memory disorder that is commonly observed in individuals who have a history of alcoholism. This condition is caused by a deficiency in thiamine, which leads to damage and haemorrhage in the mammillary bodies of the hypothalamus and the medial thalamus. Korsakoff’s syndrome often follows untreated Wernicke’s encephalopathy, which is another condition caused by thiamine deficiency.
The primary features of Korsakoff’s syndrome include anterograde amnesia, which is the inability to acquire new memories, and retrograde amnesia. Individuals with this condition may also experience confabulation, which is the production of fabricated or distorted memories to fill gaps in their recollection.
Understanding Korsakoff’s syndrome is crucial for individuals who have a history of alcoholism or thiamine deficiency. Early diagnosis and treatment can help prevent further damage and improve the individual’s quality of life. Proper nutrition and abstinence from alcohol are essential for managing this condition.
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This question is part of the following fields:
- Psychiatry
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Question 12
Incorrect
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A 23-year-old woman visits the clinic after discovering that her partner has been involved in another relationship. She expresses intense anger and reports struggling to concentrate on her upcoming college classes and track competition. She also shares that she is using her anger to fuel her training for the track meet.
What defense mechanism is she displaying?Your Answer:
Correct Answer: Sublimation
Explanation:Understanding Ego Defenses
Ego defenses are psychological mechanisms that individuals use to protect themselves from unpleasant emotions or thoughts. These defenses are classified into four levels, each with its own set of defense mechanisms. The first level, psychotic defenses, is considered pathological as it distorts reality to avoid dealing with it. The second level, immature defenses, includes projection, acting out, and projective identification. The third level, neurotic defenses, has short-term benefits but can lead to problems in the long run. These defenses include repression, rationalization, and regression. The fourth and most advanced level, mature defenses, includes altruism, sublimation, and humor.
Despite the usefulness of understanding ego defenses, their classification and definitions can be inconsistent and frustrating to learn for exams. It is important to note that these defenses are not necessarily good or bad, but rather a natural part of human behavior. By recognizing and understanding our own ego defenses, we can better manage our emotions and thoughts in a healthy way.
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This question is part of the following fields:
- Psychiatry
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Question 13
Incorrect
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A woman punishes her 10-year-old son for breaking his younger sibling's toy by removing one of his favourite toys from the shelf. Her son becomes tearful and wets his bed. He was a previously toilet-trained child.
Which ego defence mechanism is demonstrated by the 10-year-old's behaviour of wetting his bed after being punished for breaking his sibling's toy?Your Answer:
Correct Answer: Regression
Explanation:Regression refers to the involuntary process of reverting back to earlier ways of dealing with the world, which is different from fixation. This phenomenon is commonly observed in children who are experiencing stress due to factors such as illness, punishment, or the arrival of a new sibling. For instance, a child who was previously toilet-trained may start bedwetting again under such circumstances. Other related psychological concepts include reaction formation, fixation, and displacement.
Understanding Ego Defenses
Ego defenses are psychological mechanisms that individuals use to protect themselves from unpleasant emotions or thoughts. These defenses are classified into four levels, each with its own set of defense mechanisms. The first level, psychotic defenses, is considered pathological as it distorts reality to avoid dealing with it. The second level, immature defenses, includes projection, acting out, and projective identification. The third level, neurotic defenses, has short-term benefits but can lead to problems in the long run. These defenses include repression, rationalization, and regression. The fourth and most advanced level, mature defenses, includes altruism, sublimation, and humor.
Despite the usefulness of understanding ego defenses, their classification and definitions can be inconsistent and frustrating to learn for exams. It is important to note that these defenses are not necessarily good or bad, but rather a natural part of human behavior. By recognizing and understanding our own ego defenses, we can better manage our emotions and thoughts in a healthy way.
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This question is part of the following fields:
- Psychiatry
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Question 14
Incorrect
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A 29-year-old male has just been prescribed olanzapine for his schizophrenia. However, his family reports that he appears restless and has a blank stare. During your examination, you observe an upward deviation of both eyes.
What could be the reason for this?Your Answer:
Correct Answer: Oculogyric-crisis
Explanation:Acute dystonia is characterized by sustained muscle contraction, such as torticollis or oculogyric crisis. These symptoms are unlikely to be caused by a brain tumor.
Neuroleptic malignant syndrome is often triggered by the initiation of anti-dopaminergic medication or withdrawal of dopamine agonists. Symptoms include fever, sweating, muscle rigidity, and confusion. Treatment involves discontinuing anti-dopaminergic medications and sometimes starting dopamine agonists like bromocriptine. Symptomatic care, such as cooling blankets, may also be provided. Antipyretics are not effective in treating neuroleptic malignant syndrome.
Oculogyric crisis is a dystonic reaction that typically occurs shortly after starting antipsychotics, particularly older typical antipsychotics. Treatment involves stopping the medication and administering antimuscarinic drugs.
A cranial nerve III palsy would result in a ‘down and out gaze,’ while a cranial nerve VI palsy would cause an inability to effectively abduct the eye.
Antipsychotics are a type of medication used to treat schizophrenia, psychosis, mania, and agitation. They are divided into two categories: typical and atypical antipsychotics. The latter were developed to address the extrapyramidal side-effects associated with the first generation of typical antipsychotics. Typical antipsychotics work by blocking dopaminergic transmission in the mesolimbic pathways through dopamine D2 receptor antagonism. However, they are known to cause extrapyramidal side-effects such as Parkinsonism, acute dystonia, akathisia, and tardive dyskinesia. These side-effects can be managed with procyclidine. Other side-effects of typical antipsychotics include antimuscarinic effects, sedation, weight gain, raised prolactin, impaired glucose tolerance, neuroleptic malignant syndrome, reduced seizure threshold, and prolonged QT interval. The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients due to an increased risk of stroke and venous thromboembolism.
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This question is part of the following fields:
- Psychiatry
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Question 15
Incorrect
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A middle-aged staff grade doctor in general medicine is convinced that he failed his membership exams due to unjust treatment by the examiners. He has repeatedly sent letters and emails of grievance to the College and the Medical Director and he consistently feels victimized. He has encountered comparable problems in all of his past positions. Despite this, he performs well in his job and has a positive rapport with his patients. He does not exhibit any signs of psychosis. How would you characterize his demeanor?
Your Answer:
Correct Answer: Overvalued paranoid ideas
Explanation:Paranoid Overvalued Ideas
Paranoid overvalued ideas are a type of thought pattern that arises from a self-referential interpretation of events and interactions with others. Individuals with this condition tend to assume that they are being treated unfairly and will often react strongly to any perceived discrimination. Unlike psychotic disorders associated with persecutory delusions, paranoid overvalued ideas do not typically involve psychotic symptoms or impair day-to-day functioning.
An overvalued idea is a thought that takes precedence over all other ideas due to the associated feeling tone. This type of idea can maintain its precedence permanently or for an extended period of time. the nature of paranoid overvalued ideas is crucial for identifying and treating individuals who may be struggling with this condition. By recognizing the signs and symptoms of this thought pattern, mental health professionals can provide targeted interventions to help individuals overcome their negative thought patterns and improve their overall quality of life.
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This question is part of the following fields:
- Psychiatry
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Question 16
Incorrect
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A patient with intricate mental health issues and multiple medications presents at the clinic with concerns about weight gain. Which of the following medications is probable to be the cause of this side effect?
Your Answer:
Correct Answer: Olanzapine
Explanation:Weight gain is a prevalent side effect of antipsychotics.
While antipsychotics are successful in treating schizophrenia, they often lead to weight gain and an increased likelihood of developing type 2 diabetes. The most rapid weight gain typically occurs within the first six months of starting antipsychotic treatment.
In particular, Olanzapine and Clozapine are associated with a high risk of weight gain. They stimulate appetite and result in overeating, as well as disrupt glucose regulation.
Schizophrenia management guidelines were published by NICE in 2009. The guidelines recommend that first-line treatment for schizophrenia should involve oral atypical antipsychotics. Additionally, cognitive behavioural therapy should be offered to all patients. It is important to pay close attention to cardiovascular risk-factor modification due to the high rates of cardiovascular disease in schizophrenic patients, which is linked to antipsychotic medication and high smoking rates. Therefore, healthcare professionals should take necessary measures to reduce the risk of cardiovascular disease in these patients.
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This question is part of the following fields:
- Psychiatry
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Question 17
Incorrect
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A 63-year-old male with a lengthy history of schizophrenia presents at the clinic. He displays rapid darting movements of his tongue and appears to be grimacing. What is the mechanism of action of the medication that is most likely responsible for his symptoms?
Your Answer:
Correct Answer: Long term dopamine receptor blockade causing hypersensitivity of dopamine receptors in the nigrostriatal pathway
Explanation:Tardive dyskinesia is a condition that can occur as a result of long-term use of antipsychotic drugs, which is likely in this patient due to his history of mental illness. It is believed that blocking the dopamine receptor can cause hypersensitivity of the D2 receptor in the nigrostriatal pathway, leading to excessive movements.
It should be noted that antiemetic medications that use dopamine antagonism in the chemoreceptor trigger zone are more likely to cause acute dystonias rather than tardive dyskinesia. Additionally, degeneration of dopaminergic neurons in the substantia nigra is associated with Parkinson’s disease and would not produce these symptoms. Abrupt withdrawal of dopaminergic agents is also not expected to result in tardive dyskinesia. Finally, carbidopa inhibits the conversion of L-DOPA into dopamine and does not cause tardive dyskinesia.
Antipsychotics are a type of medication used to treat schizophrenia, psychosis, mania, and agitation. They are divided into two categories: typical and atypical antipsychotics. The latter were developed to address the extrapyramidal side-effects associated with the first generation of typical antipsychotics. Typical antipsychotics work by blocking dopaminergic transmission in the mesolimbic pathways through dopamine D2 receptor antagonism. However, they are known to cause extrapyramidal side-effects such as Parkinsonism, acute dystonia, akathisia, and tardive dyskinesia. These side-effects can be managed with procyclidine. Other side-effects of typical antipsychotics include antimuscarinic effects, sedation, weight gain, raised prolactin, impaired glucose tolerance, neuroleptic malignant syndrome, reduced seizure threshold, and prolonged QT interval. The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients due to an increased risk of stroke and venous thromboembolism.
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This question is part of the following fields:
- Psychiatry
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Question 18
Incorrect
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A 23-year-old man with a history of schizophrenia is placed under section 2 of the mental health act following a violent altercation with a member of the public. Upon investigation, it is discovered that he ceased taking his prescribed antipsychotic medication due to experiencing problematic gynaecomastia and nipple discharge.
Which medication has the highest occurrence of this adverse reaction?Your Answer:
Correct Answer: Risperidone
Explanation:Risperidone, an atypical antipsychotic, often causes hyperprolactinaemia as a side effect.
Atypical antipsychotics are now recommended as the first-line treatment for patients with schizophrenia, as per the 2005 NICE guidelines. These agents have a significant advantage over traditional antipsychotics in that they cause fewer extrapyramidal side-effects. However, atypical antipsychotics can still cause adverse effects such as weight gain, hyperprolactinaemia, and clozapine-associated agranulocytosis. Elderly patients who take antipsychotics are at an increased risk of stroke and venous thromboembolism, according to the Medicines and Healthcare products Regulatory Agency.
Clozapine is one of the first atypical antipsychotics to be developed, but it carries a significant risk of agranulocytosis. Therefore, full blood count monitoring is essential during treatment. Clozapine should only be used in patients who are resistant to other antipsychotic medication. The BNF recommends introducing clozapine if schizophrenia is not controlled despite the sequential use of two or more antipsychotic drugs, one of which should be a second-generation antipsychotic drug, each for at least 6-8 weeks. Clozapine can cause adverse effects such as reduced seizure threshold, constipation, myocarditis, and hypersalivation. Dose adjustment of clozapine may be necessary if smoking is started or stopped during treatment.
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This question is part of the following fields:
- Psychiatry
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Question 19
Incorrect
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A 27-year-old female presents to her GP after giving birth 8 months ago. She had planned for a normal vaginal delivery, but due to an umbilical cord prolapse, she had to undergo an emergency caesarean section. Since then, she has experienced several health changes, such as excessive sleep, joint pains, and weight loss. She also reports seeing animals around her that others cannot see and now takes a different route to work to avoid driving past the hospital where the events occurred. Based on her history, what is the most significant feature that supports a diagnosis of post-traumatic stress disorder (PTSD)?
Your Answer:
Correct Answer: Avoidance
Explanation:PTSD is characterized by a set of common features, including re-experiencing, avoidance, and hyperarousal. Patients may experience intrusive flashbacks or nightmares related to the traumatic event. PTSD can develop after exposure to a variety of traumatic events, such as accidents, natural disasters, military exposure, and traumatic births. Healthcare workers during the COVID-19 pandemic have also reported experiencing PTSD. Insomnia is a common symptom associated with PTSD, while excessive sleep is not. Although hallucinations have been reported in some patients with PTSD, they are not as common as flashbacks and should prompt doctors to consider other possible diagnoses. Joint pains may occur in patients with PTSD, but they are not a defining feature of the disease.
Understanding Post-Traumatic Stress Disorder (PTSD)
Post-traumatic stress disorder (PTSD) is a mental health condition that can develop in individuals of any age following a traumatic event. This can include natural disasters, physical or sexual assault, or military combat. PTSD is characterized by a range of symptoms, including re-experiencing the traumatic event through flashbacks or nightmares, avoidance of triggers associated with the event, hyperarousal, emotional numbing, depression, and substance abuse.
Effective management of PTSD involves a range of interventions, including watchful waiting for mild symptoms, trauma-focused cognitive behavioral therapy (CBT), and eye movement desensitization and reprocessing (EMDR) therapy for more severe cases. While drug treatments are not recommended as a first-line treatment for adults, venlafaxine or a selective serotonin reuptake inhibitor (SSRI) such as sertraline may be used. In severe cases, risperidone may be recommended. It is important to note that single-session interventions, also known as debriefing, are not recommended following a traumatic event.
Understanding PTSD and its symptoms is crucial in providing effective support and treatment for those who have experienced trauma. With the right interventions, individuals with PTSD can learn to manage their symptoms and improve their quality of life.
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This question is part of the following fields:
- Psychiatry
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Question 20
Incorrect
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A 21-year-old female is experiencing high levels of anxiety when she is in social situations. She often turns to alcohol to calm her nerves, which has resulted in a few embarrassing incidents where she has had to leave early due to being too intoxicated. As a result, she now avoids social events altogether and worries that others will view her as socially inept or strange. What is the most accurate way to describe her anxiety and fears?
Your Answer:
Correct Answer: Social phobia
Explanation:Social Phobia
Social phobia is a condition where individuals experience intense fear and avoidance of social situations. They have a constant fear of being judged or scrutinized by others due to their behavior or physical appearance. To cope with their anxiety, some individuals may resort to excessive drinking, which can lead to further problems such as aggression and disinhibition.
Treatment for social phobia typically involves a combination of medication and psychotherapy. Medications such as antidepressants and anti-anxiety drugs can help alleviate symptoms, while psychotherapy can help individuals learn coping mechanisms and develop social skills. With proper treatment, individuals with social phobia can learn to manage their anxiety and improve their quality of life.
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This question is part of the following fields:
- Psychiatry
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Question 21
Incorrect
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What category of hallucination does Jane experience when she hears someone calling her name while being alone in the house?
Your Answer:
Correct Answer: Hypnogogic hallucination
Explanation:Types of Hallucinations
Hypnogogic and hypnopompic hallucinations are two types of hallucinations that occur during the sleep cycle. Hypnogogic hallucinations happen when a person is falling asleep and can be auditory, visual, tactile, or kinaesthetic. On the other hand, hypnopompic hallucinations occur when a person is waking up, and the hallucination continues even after the person opens their eyes. These types of hallucinations are not indicative of any psychopathology and can occur in individuals with narcolepsy.
Reflex hallucinations are another type of hallucination that occurs when a true sensory stimulus causes an hallucination in another sensory modality. Autoscopy is a unique experience where an individual sees themselves and knows that it is themselves. This experience is visual and is sometimes referred to as the ‘phantom mirror image.’ Finally, auditory illusions occur when an auditory stimulus is misrepresented or misinterpreted by the listener.
In summary, there are various types of hallucinations that can occur in different stages of the sleep cycle or due to sensory stimuli. While these experiences may seem unusual, they do not necessarily indicate any underlying mental health issues.
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This question is part of the following fields:
- Psychiatry
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Question 22
Incorrect
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A 24-year-old male has just begun taking risperidone for schizophrenia. Soon after starting the medication, he observes that his breasts have become enlarged and there is some discharge. He also confesses to experiencing a decrease in libido and erectile dysfunction.
What dopaminergic pathway is being suppressed to result in this manifestation, which is diagnosed as hyperprolactinemia due to the use of antipsychotics?Your Answer:
Correct Answer: Tuberoinfundibular pathway
Explanation:Antipsychotics cause hyperprolactinaemia by inhibiting the tuberoinfundibular pathway, a dopaminergic pathway that originates from the hypothalamus and extends to the median eminence. This inhibition results in an increase in prolactin levels, which is responsible for the patient’s symptoms. Parkinson’s disease is associated with dysfunction in the nigrostriatal pathway, while schizophrenia is linked to abnormalities in the mesolimbic and mesocortical pathways. The corticospinal tract is involved in movement.
Antipsychotics are a type of medication used to treat schizophrenia, psychosis, mania, and agitation. They are divided into two categories: typical and atypical antipsychotics. The latter were developed to address the extrapyramidal side-effects associated with the first generation of typical antipsychotics. Typical antipsychotics work by blocking dopaminergic transmission in the mesolimbic pathways through dopamine D2 receptor antagonism. However, they are known to cause extrapyramidal side-effects such as Parkinsonism, acute dystonia, akathisia, and tardive dyskinesia. These side-effects can be managed with procyclidine. Other side-effects of typical antipsychotics include antimuscarinic effects, sedation, weight gain, raised prolactin, impaired glucose tolerance, neuroleptic malignant syndrome, reduced seizure threshold, and prolonged QT interval. The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients due to an increased risk of stroke and venous thromboembolism.
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This question is part of the following fields:
- Psychiatry
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Question 23
Incorrect
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Tina, who is in her mid-30s, is currently facing a challenging situation at work that is causing her to feel increasingly frustrated and angry. To cope with these emotions, she has decided to take up kickboxing as a form of release. By channeling her energy into physical activity, Tinais able to manage her anger in a healthy way. This is an example of which defense mechanism?
Your Answer:
Correct Answer: Sublimation
Explanation:Defense Mechanisms: Coping Strategies for Unacceptable Emotions
Defense mechanisms are psychological strategies that individuals use to cope with unacceptable emotions and thoughts. These mechanisms are often unconscious and can be helpful in managing difficult situations. One such mechanism is sublimation, which involves channeling negative emotions into more acceptable outlets. For example, a person who is angry may choose to engage in physical exercise as a way to release their emotions.
Another defense mechanism is displacement, which involves transferring emotions from one person or situation to another. This can be seen when a person who is angry with their boss comes home and takes out their frustration on their family members. Intellectualization is another mechanism that allows individuals to focus on the facts of a situation rather than the emotions they are feeling. This can be helpful in situations where emotions may be overwhelming, such as when dealing with a serious illness.
Rationalization is a defense mechanism that allows individuals to justify their behavior in a logical manner when their ego is threatened. For example, a student who fails an exam may blame the teacher rather than accepting responsibility for their own actions. Finally, denial is a mechanism that involves consciously avoiding painful topics. This can be seen when a patient denies being told that they have a serious illness.
Overall, defense mechanisms can be helpful in managing difficult emotions and situations. However, it is important to recognize when these mechanisms are being used and to seek help if they are interfering with daily life.
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This question is part of the following fields:
- Psychiatry
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Question 24
Incorrect
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A 42-year-old man is brought to the GP by his wife. She reports that his behaviour has become increasingly erratic and that he often appears to be listening to something that she cannot hear.
During the consultation, the GP notices that he keeps standing up and sitting down again. When questioned on these movements, the patient says, 'I can't help it, my neighbour is controlling my legs.'
What symptom is the patient experiencing?Your Answer:
Correct Answer: Passivity
Explanation:Passivity is the belief that one’s movements or sensations are controlled by an external force. Grandiose delusion is a false belief in one’s own superiority. Avolition is a decrease in motivation for purposeful activities. Catatonia is a state of unresponsiveness with repetitive movements or abnormal postures.
Schizophrenia: Symptoms and Features
Schizophrenia is a mental disorder that is characterized by a range of symptoms. One of the most prominent classifications of these symptoms is Schneider’s first rank symptoms. These symptoms can be divided into four categories: auditory hallucinations, thought disorders, passivity phenomena, and delusional perceptions. Auditory hallucinations can include hearing two or more voices discussing the patient in the third person, thought echo, or voices commenting on the patient’s behavior. Thought disorders can include thought insertion, thought withdrawal, and thought broadcasting. Passivity phenomena can include bodily sensations being controlled by external influence or experiences that are imposed on the individual or influenced by others. Delusional perceptions can involve a two-stage process where a normal object is perceived, and then there is a sudden intense delusional insight into the object’s meaning for the patient.
Other features of schizophrenia include impaired insight, incongruity/blunting of affect (inappropriate emotion for circumstances), decreased speech, neologisms (made-up words), catatonia, and negative symptoms such as anhedonia (inability to derive pleasure), alogia (poverty of speech), and avolition (poor motivation). It is important to note that not all individuals with schizophrenia will experience all of these symptoms, and the severity of symptoms can vary from person to person.
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This question is part of the following fields:
- Psychiatry
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Question 25
Incorrect
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As a new resident on the medical assessment unit, you are attending a consultant-led ward round. A 45-year-old male with a history of alcohol-related liver failure becomes agitated and threatens to punch the consultant. He displays coarse tremors in both hands and appears highly anxious.
The patient is a chronic alcoholic.
What is the preferred medication for managing his symptoms?Your Answer:
Correct Answer: Lorazepam
Explanation:To prevent increased sedation, lorazepam is the preferred medication for alcohol withdrawal syndrome in patients with hepatic failure, rather than chlordiazepoxide. Naloxone is used for opioid overdose and respiratory depression caused by opioids, while flumazenil is not used for alcohol withdrawal management as it counteracts the effects of benzodiazepines.
Alcohol withdrawal occurs when an individual who has been consuming alcohol chronically suddenly stops or reduces their intake. This is due to the fact that chronic alcohol consumption enhances GABA-mediated inhibition in the central nervous system (CNS), similar to benzodiazepines, and inhibits NMDA-type glutamate receptors. When alcohol consumption is stopped, the opposite occurs, resulting in decreased inhibitory GABA and increased NMDA glutamate transmission.
Symptoms of alcohol withdrawal typically start within 6-12 hours and include tremors, sweating, tachycardia, and anxiety. Seizures are most likely to occur at around 36 hours, while delirium tremens, which is characterized by coarse tremors, confusion, delusions, auditory and visual hallucinations, fever, and tachycardia, is most likely to occur at around 48-72 hours.
Patients with a history of complex withdrawals from alcohol, such as delirium tremens, seizures, or blackouts, should be admitted to the hospital for monitoring until their withdrawals stabilize. The first-line treatment for alcohol withdrawal is long-acting benzodiazepines, such as chlordiazepoxide or diazepam, which are typically given as part of a reducing dose protocol. Lorazepam may be preferable in patients with hepatic failure. Carbamazepine is also effective in treating alcohol withdrawal, while phenytoin is said not to be as effective in the treatment of alcohol withdrawal seizures.
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This question is part of the following fields:
- Psychiatry
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Question 26
Incorrect
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Oliver takes medication for a heart condition. He notices that everything he sees appears to be tinged with yellow.
What term could be used to describe this symptom?Your Answer:
Correct Answer: Xanthopsia
Explanation:Types of Visual Perceptions and Distortions
Xanthopsia, chloropsia, and erythropsia are all types of visual perceptions that involve a predominant color. Xanthopsia, in particular, is often caused by digitalis toxicity. Autoscopy, on the other hand, is a type of visual hallucination where an individual sees themselves and knows it is them. Dysmegalopsia, micropsia, and macropsia all describe changes in the perceived shape or size of an object. Hyperaesthesia, meanwhile, refers to an increased intensity of sensation, which can be uncomfortable for some individuals. Lastly, pareidolia is a visual illusion where an individual perceives an image in an otherwise vague or obscure stimulus.
It is important to note that sensory distortions can occur in any sense modality, not just in vision. These types of perceptions and distortions can be caused by various factors, such as medication side effects, neurological conditions, or even psychological states. these phenomena can help individuals recognize and seek appropriate treatment if necessary.
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This question is part of the following fields:
- Psychiatry
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Question 27
Incorrect
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A middle-aged woman presents with complaints of profound sadness, marked difficulty concentrating, and an inability to make decisions. During the evaluation, she speaks slowly and struggles to articulate her emotions. How would you characterize the alterations in her cognitive functioning and thought processes?
Your Answer:
Correct Answer: Psychomotor retardation
Explanation:Psychomotor Retardation in Severe Depression
Psychomotor retardation is a cognitive symptom commonly observed in individuals with severe depression. It is characterized by a significant slowing down of both thinking and behavior. This symptom can manifest in various ways, such as slowed speech, reduced movement, and delayed responses. Psychomotor retardation can significantly impact an individual’s ability to carry out daily activities and can lead to social withdrawal and isolation.
It is essential to differentiate psychomotor retardation from other forms of thought disorders seen in other psychiatric conditions such as mania and schizophrenia. In mania, individuals may experience racing thoughts and increased energy levels, while in schizophrenia, disorganized thinking and speech patterns are common. Therefore, a thorough evaluation by a mental health professional is necessary to accurately diagnose and treat psychomotor retardation in severe depression.
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This question is part of the following fields:
- Psychiatry
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Question 28
Incorrect
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A 24-year-old man visits his GP clinic and requests a referral to a plastic surgeon. He is worried that his ears are too large compared to his face. This has caused him to become reclusive and he has lost his employment. Upon examination, his ears seem to be of normal size. What is the most suitable term for this conduct?
Your Answer:
Correct Answer: Dysmorphophobia
Explanation:Understanding Body Dysmorphic Disorder
Body dysmorphic disorder, also known as dysmorphophobia, is a mental health condition that affects a person’s perception of their physical appearance. Individuals with this disorder have a distorted body image, which causes them to obsess over perceived flaws or defects in their appearance. Even if there is only a slight physical abnormality, the person’s concern is excessive and can lead to significant distress or impairment in their daily life.
According to the Diagnostic and Statistical Manual (DSM) IV criteria, the preoccupation with the imagined defect must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. It is important to note that this preoccupation is not better accounted for by another mental disorder, such as dissatisfaction with body shape and size in Anorexia Nervosa.
Body dysmorphic disorder can have a significant impact on a person’s mental health and quality of life. It is important for individuals who may be experiencing symptoms of this disorder to seek professional help from a mental health provider. With proper treatment, individuals with body dysmorphic disorder can learn to manage their symptoms and improve their overall well-being.
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This question is part of the following fields:
- Psychiatry
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Question 29
Incorrect
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A 30-year-old male presents to a mental health specialist with a belief that the government has taken over his body. He is prescribed an antipsychotic medication. What are the potential side effects of this type of medication?
Your Answer:
Correct Answer: Metabolic syndrome
Explanation:Antipsychotics block dopamine receptors, resulting in a broad range of side effects. These may include dystonia, dyskinesia, antiemetic effects, and hyperprolactinemia. Additionally, antipsychotics can cause metabolic syndrome and a prolonged QT interval, so caution is necessary. The other choices do not pertain to the side effects of antipsychotics.
Antipsychotics are a type of medication used to treat schizophrenia, psychosis, mania, and agitation. They are divided into two categories: typical and atypical antipsychotics. The latter were developed to address the extrapyramidal side-effects associated with the first generation of typical antipsychotics. Typical antipsychotics work by blocking dopaminergic transmission in the mesolimbic pathways through dopamine D2 receptor antagonism. However, they are known to cause extrapyramidal side-effects such as Parkinsonism, acute dystonia, akathisia, and tardive dyskinesia. These side-effects can be managed with procyclidine. Other side-effects of typical antipsychotics include antimuscarinic effects, sedation, weight gain, raised prolactin, impaired glucose tolerance, neuroleptic malignant syndrome, reduced seizure threshold, and prolonged QT interval. The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients due to an increased risk of stroke and venous thromboembolism.
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This question is part of the following fields:
- Psychiatry
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Question 30
Incorrect
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A 20-year-old woman is brought in by her family. They report that she has been isolating herself and has not left the house for a few months. They suspect that she is experiencing auditory hallucinations and has been refusing to eat, believing that the food is contaminated. What is the recommended initial treatment for her probable diagnosis?
Your Answer:
Correct Answer: Olanzapine
Explanation:Clozapine is typically reserved for patients who do not respond to other antipsychotic medications, as it has the potential to cause serious side effects. Based on the symptoms described in the scenario, the most likely diagnosis is schizophrenia, which is typically treated with antipsychotic medications such as Olanzapine. Sertraline is an SSRI commonly used for depression and anxiety, while Sodium Valproate is a mood stabilizer used in bipolar disorder and epilepsy.
Schizophrenia management guidelines were published by NICE in 2009. The guidelines recommend that first-line treatment for schizophrenia should involve oral atypical antipsychotics. Additionally, cognitive behavioural therapy should be offered to all patients. It is important to pay close attention to cardiovascular risk-factor modification due to the high rates of cardiovascular disease in schizophrenic patients, which is linked to antipsychotic medication and high smoking rates. Therefore, healthcare professionals should take necessary measures to reduce the risk of cardiovascular disease in these patients.
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This question is part of the following fields:
- Psychiatry
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