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  • Question 1 - A 28-year-old woman comes in with anxiety. She also exhibits symptoms of dry...

    Correct

    • A 28-year-old woman comes in with anxiety. She also exhibits symptoms of dry mouth, coughing, lower body temperature, altered perception of time and space, and bloodshot eyes. What is the MOST LIKELY diagnosis?

      Your Answer: Cannabis use

      Explanation:

      The clinical manifestations of cannabis use encompass various aspects. Firstly, it can amplify pre-existing mood states, leading to feelings of euphoria, depression, or anxiety. Additionally, cannabis can distort one’s perception of time and space, creating a sense of disorientation. It also enhances the enjoyment of aesthetic experiences, making them more pleasurable. Visual hallucinations may also occur as a result of cannabis use. Physiological effects include dry mouth, coughing, and irritation of the respiratory tract. Furthermore, cannabis use often leads to an increased appetite and a decrease in body temperature. Reddened eyes and respiratory tract irritation are also common symptoms associated with cannabis use.

    • This question is part of the following fields:

      • Mental Health
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  • Question 2 - A 25-year-old woman with a history of schizophrenia is brought to the Emergency...

    Incorrect

    • A 25-year-old woman with a history of schizophrenia is brought to the Emergency Department. She is exhibiting signs of acute psychosis.
      Which ONE of the following is acknowledged as a primary symptom of schizophrenia?

      Your Answer: Social withdrawal

      Correct Answer: Thought echo

      Explanation:

      The first-rank symptoms of schizophrenia, as described by Kurt Schneider, include auditory hallucinations such as hearing 3rd person voices discussing the patient, experiencing thought echo, and receiving commentary on one’s actions. Additionally, passivity phenomena may occur, such as thought insertion, thought withdrawal, thought broadcast, and feelings of thoughts and actions being under external control. Delusions, which can be primary or secondary, are also common in schizophrenia.

      On the other hand, chronic schizophrenia is characterized by negative symptoms. These include poor motivation and self-care, social withdrawal, depression, flat and blunted affect, emotional incongruity, decreased activity, and poverty of thought and speech. These negative symptoms often persist in individuals with chronic schizophrenia.

    • This question is part of the following fields:

      • Mental Health
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  • Question 3 - A middle-aged patient with a long-standing history of alcohol abuse presents feeling extremely...

    Incorrect

    • A middle-aged patient with a long-standing history of alcohol abuse presents feeling extremely ill. He has been on a week-long drinking spree and has consumed very little food during that time. After conducting tests, you diagnose him with alcoholic ketoacidosis.
      What type of acid-base disorder would you anticipate in a patient with alcoholic ketoacidosis?

      Your Answer: Respiratory acidosis

      Correct Answer: Raised anion gap metabolic acidosis

      Explanation:

      Respiratory alkalosis can be caused by hyperventilation, such as during periods of anxiety. It can also be a result of conditions like pulmonary embolism, CNS disorders (such as stroke or encephalitis), altitude, pregnancy, or the early stages of aspirin overdose.

      Respiratory acidosis is often associated with chronic obstructive pulmonary disease (COPD) or life-threatening asthma. Other causes include pulmonary edema, sedative drug overdose (such as opiates or benzodiazepines), neuromuscular disease, obesity, or certain medications.

      Metabolic alkalosis can occur due to vomiting, potassium depletion (often caused by diuretic usage), Cushing’s syndrome, or Conn’s syndrome.

      Metabolic acidosis with a raised anion gap can be caused by conditions like lactic acidosis (which can result from hypoxemia, shock, sepsis, or infarction) or ketoacidosis (commonly seen in diabetes, starvation, or alcohol excess). Other causes include renal failure or poisoning (such as late stages of aspirin overdose, methanol, or ethylene glycol).

      Metabolic acidosis with a normal anion gap can be attributed to conditions like renal tubular acidosis, diarrhea, ammonium chloride ingestion, or adrenal insufficiency.

    • This question is part of the following fields:

      • Mental Health
      67.8
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  • Question 4 - You evaluate a 35-year-old combat veteran named Mark, who was recently discharged from...

    Correct

    • You evaluate a 35-year-old combat veteran named Mark, who was recently discharged from service after being discovered to be under the influence of drugs and alcohol during a training exercise. He completed three tours of duty in Iraq and witnessed the death of a close comrade during his final deployment. Mark acknowledges experiencing frequent flashbacks and nightmares and often feels on edge. His spouse has accused him of being emotionally distant and lacking feelings, resulting in their separation. Lately, he has been heavily relying on alcohol as a coping mechanism.
      What is the SINGLE MOST probable diagnosis?

      Your Answer: Post-traumatic stress disorder

      Explanation:

      Post-traumatic stress disorder (PTSD) develops after experiencing an extremely threatening or catastrophic event that would cause distress in almost anyone. It is important to note that PTSD does not develop from everyday upsetting situations like divorce, job loss, or failing an exam.

      The most common symptom of PTSD is re-experiencing the traumatic event involuntarily and vividly. This can manifest as flashbacks, nightmares, repetitive distressing images or sensations, and physical symptoms such as pain, sweating, nausea, or trembling. Other notable features of PTSD include avoidance, rumination, hyperarousal, emotional numbing, irritability, and insomnia.

      It is common for individuals with PTSD to also experience other mental health problems such as depression, anxiety, phobias, self-harming behaviors, and substance abuse.

      The recommended treatments for PTSD are Eye Movement Desensitization and Reprocessing (EMDR) and Trauma-focused Cognitive Behavioral Therapy (CBT). These treatments should be offered to individuals of all ages, regardless of the time that has passed since the traumatic event. Typically, 8-12 sessions are recommended, but more may be necessary in cases involving multiple traumas, chronic disability, comorbidities, or social problems.

    • This question is part of the following fields:

      • Mental Health
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  • Question 5 - A 32-year-old woman has been brought into the Emergency Department by the Police...

    Incorrect

    • A 32-year-old woman has been brought into the Emergency Department by the Police with unusual behavior. She has been brought in under 'section'. She is known to suffer from bipolar disorder, but her friend states that she hasn't been taking her medications recently. She became agitated, violent, and aggressive after being approached by the Police and is now handcuffed. She is saying that she hears voices and that she can read people's minds. She is refusing oral medications.
      According to the NICE guidelines for short-term management of violent and aggressive patients, what should be used as the first-line for rapid tranquilization of this patient?

      Your Answer: Haloperidol alone

      Correct Answer: Haloperidol plus promethazine

      Explanation:

      Rapid tranquillisation involves the administration of medication through injection when oral medication is not feasible or appropriate and immediate sedation is necessary. The current guidelines from NICE recommend two options for rapid tranquillisation in adults: intramuscular lorazepam alone or a combination of intramuscular haloperidol and intramuscular promethazine. The choice of medication depends on various factors such as advanced statements, potential intoxication, previous responses to these medications, interactions with other drugs, and existing physical health conditions or pregnancy.

      If there is insufficient information to determine the appropriate medication or if the individual has not taken antipsychotic medication before, intramuscular lorazepam is recommended. However, if there is evidence of cardiovascular disease or a prolonged QT interval, or if an electrocardiogram has not been conducted, the combination of intramuscular haloperidol and intramuscular promethazine should be avoided, and intramuscular lorazepam should be used instead.

      If there is a partial response to intramuscular lorazepam, a second dose should be considered. If there is no response to intramuscular lorazepam, then intramuscular haloperidol combined with intramuscular promethazine should be considered. If there is a partial response to this combination, a further dose should be considered.

      If there is no response to intramuscular haloperidol combined with intramuscular promethazine and intramuscular lorazepam has not been used yet, it should be considered. However, if intramuscular lorazepam has already been administered, it is recommended to arrange an urgent team meeting to review the situation and seek a second opinion if necessary.

      After rapid tranquillisation, the patient should be closely monitored for any side effects, and their vital signs should be regularly checked, including heart rate, blood pressure, respiratory rate, temperature, hydration level, and level of consciousness. These observations should be conducted at least hourly until there are no further concerns about the patient’s physical health.

      For more information, refer to the NICE guidance on violence and aggression: short-term management in mental health, health, and community settings.

    • This question is part of the following fields:

      • Mental Health
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  • Question 6 - You assess a client with a history of schizophrenia who is currently experiencing...

    Incorrect

    • You assess a client with a history of schizophrenia who is currently experiencing acute psychosis. He reports a sensation in which he believes that individuals in close proximity to him are inserting their thoughts into his mind.
      Which ONE of the following thought disorders is he exhibiting?

      Your Answer: Thought echo

      Correct Answer: Thought insertion

      Explanation:

      Thought insertion is one of the primary symptoms identified by Schneider in schizophrenia. This symptom refers to the patient’s belief that their thoughts are being controlled or influenced by external sources, such as other individuals or entities. In some cases, they may even experience auditory hallucinations, hearing distinct voices.

    • This question is part of the following fields:

      • Mental Health
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  • Question 7 - You assess a client who has recently developed severe depression and contemplate the...

    Correct

    • You assess a client who has recently developed severe depression and contemplate the potential presence of an underlying organic factor contributing to this condition.

      Which ONE of the following could be a potential organic factor leading to depression?

      Your Answer: Hypercalcaemia

      Explanation:

      Hypercalcaemia is often linked to feelings of sadness and low mood, while hypocalcaemia does not typically have this association. Temporal arteritis is known to cause sudden episodes of psychosis, but it is not commonly associated with depression. On the other hand, hyperkalaemia does not have a connection to depression. Lastly, when someone experiences a deficiency in thiamine, they may exhibit symptoms of acute confusion, but depression is not typically one of these symptoms.

    • This question is part of the following fields:

      • Mental Health
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  • Question 8 - A 32-year-old woman with a history of schizophrenia describes a sensation in which...

    Correct

    • A 32-year-old woman with a history of schizophrenia describes a sensation in which she feels that other people can hear what she is thinking. She is finding the sensation very distressing.
      Which ONE of the following thought disorders is she exhibiting?

      Your Answer: Thought broadcast

      Explanation:

      Thought broadcast is one of the primary symptoms of schizophrenia identified by Schneider. This symptom refers to the patient’s belief that their thoughts can be perceived by others.

    • This question is part of the following fields:

      • Mental Health
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  • Question 9 - You assess a client who has recently experienced a significant decline in mood...

    Correct

    • You assess a client who has recently experienced a significant decline in mood and has been contemplating self-harm. Which ONE of the following characteristics is NOT indicative of depression?

      Your Answer: Increased reactivity

      Explanation:

      Loss of reactivity, in contrast to heightened reactivity, is a common trait seen in individuals with depression. The clinical manifestations of depression encompass various symptoms. These include experiencing a persistent low mood, which may fluctuate throughout the day. Another prominent feature is anhedonia, which refers to a diminished ability to experience pleasure. Additionally, individuals with depression often exhibit antipathy, displaying a lack of interest or enthusiasm towards activities or people. Their speech may become slow and have a reduced volume. They may also struggle with maintaining attention and concentration. Furthermore, depression can lead to a decrease in self-esteem, accompanied by thoughts of guilt and worthlessness. Insomnia, particularly early morning waking, is a classic symptom of depression. Other common signs include a decrease in libido, low energy levels, increased fatigue, and a poor appetite resulting in weight loss.

    • This question is part of the following fields:

      • Mental Health
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  • Question 10 - A 40-year-old woman comes in with tremors, anxiety, sweating, and nausea. Her vital...

    Incorrect

    • A 40-year-old woman comes in with tremors, anxiety, sweating, and nausea. Her vital signs reveal an elevated heart rate of 119 bpm. She typically consumes 2-3 large bottles of strong cider daily but has recently run out of money and has not had an alcoholic beverage since the previous evening.
      Which ONE of the following medications, not belonging to the benzodiazepine class, is commonly prescribed in the UK for the treatment of alcohol withdrawal symptoms?

      Your Answer: Diazepam

      Correct Answer: Carbamazepine

      Explanation:

      Benzodiazepines are commonly used in the UK to manage symptoms of alcohol withdrawal. Currently, only diazepam and chlordiazepoxide have been authorized for this purpose. Other benzodiazepines like alprazolam, clobazam, and lorazepam do not currently have authorization for treating alcohol withdrawal symptoms in the UK.

      Carbamazepine is also used in the UK to manage alcohol-related withdrawal symptoms, but it does not have official authorization for this use.

      Clomethiazole, on the other hand, does have UK marketing authorization for treating alcohol withdrawal symptoms, but it is only recommended for use in a hospital setting with close supervision. The product information for clomethiazole advises caution when prescribing it to individuals with a history of addiction or outpatient alcoholics. It is also not recommended for patients who continue to drink or abuse alcohol. Combining alcohol with clomethiazole, especially in alcoholics with cirrhosis, can lead to fatal respiratory depression even with short-term use. Therefore, clomethiazole should only be used in a hospital under close supervision or, in rare cases, by specialist units on an outpatient basis with careful monitoring of the daily dosage.

    • This question is part of the following fields:

      • Mental Health
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  • Question 11 - A 32-year-old woman with a history of schizophrenia describes a sensation in which...

    Correct

    • A 32-year-old woman with a history of schizophrenia describes a sensation in which her thoughts are heard as if they are being spoken aloud. She states that it feels almost as though her thoughts are ‘being echoed by a voice in her mind’. She hears the voice at the exact same time as thinking the thoughts.
      Which ONE of the following thought disorders is she displaying?

      Your Answer: Gedankenlautwerden

      Explanation:

      Thought echo is a phenomenon where a patient perceives their own thoughts as if they are being spoken out loud. When there is a slight delay in this perception, it is referred to as echo de la pensée. On the other hand, when the thoughts are heard simultaneously, it is known as Gedankenlautwerden.

    • This question is part of the following fields:

      • Mental Health
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  • Question 12 - A 35-year-old homeless woman with a history of mental health issues and substance...

    Incorrect

    • A 35-year-old homeless woman with a history of mental health issues and substance abuse comes to the Emergency Department with symptoms of tremors, anxiety, sweating, and nausea. Her vital signs reveal an elevated heart rate of 123 bpm. After establishing an IV line, blood samples are sent to the laboratory. She typically consumes a bottle of whiskey daily but has not had any alcohol since the previous evening. To alleviate her symptoms, you administer a dose of chlordiazepoxide.
      What other medication will you administer to her during her stay in the Emergency Department?

      Your Answer: Oral thiamine

      Correct Answer: Intravenous Pabrinex

      Explanation:

      Thiamine deficiency is frequently seen in individuals who are dependent on alcohol. This is primarily due to their inadequate diet, the presence of gastritis which affects thiamine absorption, and the fact that thiamine is involved in alcohol metabolism as a coenzyme. If left untreated, thiamine deficiency can lead to Wernicke’s encephalopathy, which can further progress to Korsakoff’s syndrome.

      It is important to note that administering glucose-containing intravenous fluids without thiamine to a patient with chronic thiamine deficiency can trigger Wernicke’s encephalopathy. Therefore, individuals undergoing detoxification should receive parenteral high-potency B complex vitamins (Pabrinex) as a preventive treatment. However, it is crucial to have resuscitation facilities available during administration due to the risk of anaphylaxis. The risk of anaphylaxis is lower when the drug is given intramuscularly (IM). A daily dose of one pair of ampoules of Pabrinex, containing 250 mg of thiamine, should be administered IM or intravenously (IV) for a period of three to five days.

      Once the 3-5 day course of Pabrinex is completed, the patient should transition to oral vitamin B Compound-strong and oral thiamine tablets for continued treatment.

      For more information, please refer to the NICE pathway for acute alcohol withdrawal.

    • This question is part of the following fields:

      • Mental Health
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  • Question 13 - A 45-year-old woman is brought in by her family due to her recent...

    Incorrect

    • A 45-year-old woman is brought in by her family due to her recent history of strange behavior. She is unable to recall events from a few years ago and also has difficulty answering questions about what has happened over the past few days. She attributes her poor memory to a recent car accident she was involved in. Her family reports that she drinks excessively. She also provides peculiar explanations to some other inquiries but remains friendly and polite during the consultation.
      Which of the following is the MOST LIKELY diagnosis?

      Your Answer: Wernicke’s encephalopathy

      Correct Answer: Korsakoff syndrome

      Explanation:

      Korsakoff syndrome is a form of dementia that occurs due to a lack of thiamine (vitamin B1) in the body. This condition is most commonly observed in individuals who have a long history of alcoholism. The main features of Korsakoff syndrome include anterograde amnesia, patchy retrograde amnesia, and confabulation. Additionally, many patients also experience difficulties with language (aphasia), movement (apraxia), recognition (agnosia), or executive functioning. It is important to note that Korsakoff syndrome often coexists with Wernicke’s encephalopathy, which is characterized by a triad of symptoms including ophthalmoplegia, altered mental state, and gait disturbance (ataxia). When both conditions are present, it is referred to as Wernicke-Korsakoff syndrome (WKS).

    • This question is part of the following fields:

      • Mental Health
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  • Question 14 - A 25-year-old woman with a known history of generalized anxiety disorder presents hyperventilating....

    Incorrect

    • A 25-year-old woman with a known history of generalized anxiety disorder presents hyperventilating. You suspect that she is experiencing a panic attack. She was seen by a resident physician shortly before your assessment, and an arterial blood gas was taken.
      What type of acid-base disorder would you anticipate being caused by hyperventilation secondary to anxiety?

      Your Answer: Normal anion gap metabolic acidosis

      Correct Answer: Respiratory alkalosis

      Explanation:

      Respiratory alkalosis can be caused by hyperventilation, such as during periods of anxiety. It can also be a result of conditions like pulmonary embolism, CNS disorders (such as stroke or encephalitis), altitude, pregnancy, or the early stages of aspirin overdose.

      Respiratory acidosis is often associated with chronic obstructive pulmonary disease (COPD) or life-threatening asthma. Other causes include pulmonary edema, sedative drug overdose (such as opiates or benzodiazepines), neuromuscular disease, obesity, or certain medications.

      Metabolic alkalosis can occur due to vomiting, potassium depletion (often caused by diuretic usage), Cushing’s syndrome, or Conn’s syndrome.

      Metabolic acidosis with a raised anion gap can be caused by conditions like lactic acidosis (which can result from hypoxemia, shock, sepsis, or infarction) or ketoacidosis (commonly seen in diabetes, starvation, or alcohol excess). Other causes include renal failure or poisoning (such as late stages of aspirin overdose, methanol, or ethylene glycol).

      Metabolic acidosis with a normal anion gap can be attributed to conditions like renal tubular acidosis, diarrhea, ammonium chloride ingestion, or adrenal insufficiency.

    • This question is part of the following fields:

      • Mental Health
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  • Question 15 - You review a child with a history of autism who is currently experiencing...

    Incorrect

    • You review a child with a history of autism who is currently experiencing severe communication difficulties. You attempt to engage in conversation with the child but find it challenging to comprehend their speech. Their language lacks coherence and seems to consist of random words and phrases.
      Which ONE of the following communication disorders is the child displaying?

      Your Answer: Graphorrhea

      Correct Answer: Word salad

      Explanation:

      A word salad refers to a jumbled or incomprehensible combination of seemingly arbitrary words and phrases. This phenomenon is frequently observed in individuals with schizophrenia and dementia.

    • This question is part of the following fields:

      • Mental Health
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  • Question 16 - A father brings his 3-year-old daughter to the Emergency Department. They have previously...

    Incorrect

    • A father brings his 3-year-old daughter to the Emergency Department. They have previously presented 8 times over the past nine months and on each occasion have been discharged. She has previously been investigated for multiple episodes of abdominal pain, and no cause found. Investigations have included routine blood tests, a negative ultrasound for appendicitis, and a negative CT scan. Four weeks ago, she presented with dad being concerned about the possibility of a urinary tract infection but was discharged without treatment, and dad had been reassured. Today she has presented having had several alleged episodes of diarrhea and vomiting at home. She has not been eating or drinking and has been spiking fevers. She appears undistressed and has had no witnessed vomiting episodes in the department. Her observations today are: temperature: 37.0°C, heart rate 110 bpm, SaO2 99% on air, RR 30, capillary refill time <2 seconds.
      What is the SINGLE most likely diagnosis?

      Your Answer: Somatic symptom disorder

      Correct Answer: Meadow syndrome

      Explanation:

      Meadow syndrome, formerly known as Munchausen syndrome by proxy, is the most likely diagnosis in this case. It involves a caregiver intentionally creating the appearance of health problems in another person, usually their own child. This can involve causing harm to the child or manipulating test results to make it seem like the child is sick or injured.

      There are several features that support a diagnosis of Meadow syndrome. These include symptoms or signs that only appear when the parent or guardian is present, symptoms that are only observed by the parent or guardian, and symptoms that do not respond to treatment or medication. Additionally, there may be a history of unlikely illnesses, such as a significant amount of blood loss without any change in physiological data. The parent or guardian may also seek multiple clinical opinions despite already receiving a definitive opinion, and they may persistently disagree with the clinical opinion.

      Another characteristic of Meadow syndrome is the significant impact it has on the child’s normal activities, such as frequent school absenteeism. The child may also use aids to daily living that are seemingly unnecessary, like a wheelchair. It is important to note that a principal risk factor for this condition is the parent having experienced a negative event or trauma during their own childhood, such as the death of a parent or being a victim of child abuse or neglect.

      It is crucial not to confuse Meadow syndrome with Munchausen syndrome, where an individual pretends to be ill or deliberately produces symptoms in themselves. Hypochondriasis is another condition where a person excessively worries about having a serious illness. Somatic symptom disorder, previously known as somatisation disorder, is characterized by an intense focus on physical symptoms that causes significant emotional distress and impairs functioning. Lastly, Ganser syndrome is a rare dissociative disorder that involves giving nonsensical or incorrect answers to questions and experiencing other dissociative symptoms like fugue, amnesia, or conversion disorder, often accompanied by visual pseudohallucinations and a decreased state of consciousness.

    • This question is part of the following fields:

      • Mental Health
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  • Question 17 - A 45-year-old man presents with a history of anxiety and thoughts of self-harm....

    Incorrect

    • A 45-year-old man presents with a history of anxiety and thoughts of self-harm. You utilize the modified SAD PERSONS score to evaluate his risk.
      Which ONE of the following statements is accurate regarding this risk assessment tool?

      Your Answer: A score of 4 would indicate the patient requires hospital admission

      Correct Answer: A history of divorce indicates increased risk

      Explanation:

      The modified SAD PERSONS scoring system is a valuable tool used to evaluate a patient’s risk of suicide. This scoring system consists of ten yes/no questions, and points are assigned for each affirmative answer. The points are distributed as follows: 1 point for being male, 1 point for being younger than 19 or older than 45 years, 2 points for experiencing depression or hopelessness, 1 point for having a history of previous suicidal attempts or psychiatric care, 1 point for excessive alcohol or drug use, 2 points for exhibiting a loss of rational thinking due to psychotic or organic illness, 1 point for being single, widowed, or divorced, 2 points for an organized or serious suicide attempt, 1 point for lacking social support, and 2 points for expressing future intent to repeat or being ambivalent about suicide.

      Based on the total score, the patient’s risk level can be determined. A score of 0-5 suggests that it may be safe to discharge the patient or provide outpatient management, depending on the circumstances. A score of 6-8 indicates that the patient probably requires psychiatric consultation. Finally, a score higher than 8 suggests that the patient likely requires hospital admission for further evaluation and care. This scoring system helps healthcare professionals make informed decisions regarding the appropriate level of intervention and support needed for patients at risk of suicide.

    • This question is part of the following fields:

      • Mental Health
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  • Question 18 - A 40-year-old woman comes in with tremors, anxiety, sweating, and nausea. Her vital...

    Incorrect

    • A 40-year-old woman comes in with tremors, anxiety, sweating, and nausea. Her vital signs reveal an elevated heart rate of 119 bpm. She typically consumes 2-3 large bottles of strong cider daily but has recently run out of money and has not had an alcoholic beverage since the previous evening.
      Which ONE of the following benzodiazepine medications is currently approved for use in clinical practice in the UK for treating symptoms of alcohol withdrawal?

      Your Answer: Lorazepam

      Correct Answer: Diazepam

      Explanation:

      Benzodiazepines are commonly used in the UK to manage symptoms of alcohol withdrawal. Currently, only diazepam and chlordiazepoxide have been authorized for this purpose. Other benzodiazepines like alprazolam, clobazam, and lorazepam do not currently have authorization for treating alcohol withdrawal symptoms in the UK.

      Carbamazepine is also used in the UK to manage alcohol-related withdrawal symptoms, but it does not have official authorization for this use.

      Clomethiazole, on the other hand, does have UK marketing authorization for treating alcohol withdrawal symptoms, but it is only recommended for use in a hospital setting with close supervision. The product information for clomethiazole advises caution when prescribing it to individuals with a history of addiction or outpatient alcoholics. It is also not recommended for patients who continue to drink or abuse alcohol. Combining alcohol with clomethiazole, especially in alcoholics with cirrhosis, can lead to fatal respiratory depression even with short-term use. Therefore, clomethiazole should only be used in a hospital under close supervision or, in rare cases, by specialist units on an outpatient basis with careful monitoring of the daily dosage.

    • This question is part of the following fields:

      • Mental Health
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  • Question 19 - A 30-year-old woman with a history of schizophrenia is brought to the Emergency...

    Incorrect

    • A 30-year-old woman with a history of schizophrenia is brought to the Emergency Department. She is exhibiting signs of acute psychosis.
      Which ONE of the following statements is TRUE regarding schizophrenia?

      Your Answer: There is no genetic predisposition

      Correct Answer: 10% of patients go on to commit suicide

      Explanation:

      The occurrence of schizophrenia is consistent across all social classes. It affects individuals from all walks of life without discrimination. The likelihood of developing schizophrenia over one’s lifetime is 1%, and this probability remains the same for both men and women. However, it is worth noting that men tend to experience the onset of symptoms at a younger age compared to women, with the average age of onset falling between 15 and 45 years.

      There is a recognized genetic predisposition for schizophrenia, meaning that certain individuals may have a higher likelihood of developing the condition due to their genetic makeup. The risk of schizophrenia affecting first-degree relatives, such as siblings or parents, is approximately 10%. Furthermore, the risk of children being affected by schizophrenia increases to 40%.

      When considering the impact of genetics on schizophrenia, it is interesting to note that monozygotic twins, who share identical genetic material, have a concordance rate of around 50%. This suggests that genetic factors play a significant role in the development of the condition.

      Tragically, approximately 10% of individuals suffering from schizophrenia ultimately die by suicide, particularly during the early stages of the illness. This highlights the importance of providing appropriate support and intervention to individuals with schizophrenia to prevent such devastating outcomes.

    • This question is part of the following fields:

      • Mental Health
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  • Question 20 - You assess a 42-year-old individual who is being admitted for alcohol detoxification. They...

    Incorrect

    • You assess a 42-year-old individual who is being admitted for alcohol detoxification. They have been prescribed Pabrinex by one of your colleagues.
      Which of the following vitamins is not included in Pabrinex?

      Your Answer: Vitamin B6

      Correct Answer: Vitamin B12

      Explanation:

      Pabrinex is a supplement that includes a combination of essential vitamins. These vitamins are Thiamine (also known as vitamin B1), Riboflavin (commonly referred to as vitamin B2), Nicotinamide (which encompasses Vitamin B3, niacin, and nicotinic acid), Pyridoxine (known as vitamin B6), and Ascorbic acid (which is vitamin C). Each of these vitamins plays a crucial role in maintaining our overall health and well-being. By incorporating Pabrinex into our daily routine, we can ensure that our bodies receive the necessary nutrients to support various bodily functions.

    • This question is part of the following fields:

      • Mental Health
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  • Question 21 - You assess a 42-year-old individual who is being admitted for alcohol detoxification. They...

    Incorrect

    • You assess a 42-year-old individual who is being admitted for alcohol detoxification. They have been prescribed Pabrinex by one of your colleagues.
      What vitamin is included in Pabrinex?

      Your Answer: Vitamin B12

      Correct Answer: Vitamin C

      Explanation:

      Pabrinex is a supplement that includes a combination of essential vitamins. These vitamins are Thiamine (also known as vitamin B1), Riboflavin (commonly referred to as vitamin B2), Nicotinamide (which encompasses Vitamin B3, niacin, and nicotinic acid), Pyridoxine (known as vitamin B6), and Ascorbic acid (which is vitamin C). Each of these vitamins plays a crucial role in maintaining our overall health and well-being. By incorporating Pabrinex into our daily routine, we can ensure that our bodies receive the necessary nutrients to support various bodily functions.

    • This question is part of the following fields:

      • Mental Health
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  • Question 22 - A teenager comes to the Emergency Department, who is known to have a...

    Correct

    • A teenager comes to the Emergency Department, who is known to have a history of substance abuse. In the waiting area, they become aggressive and start demanding to be seen immediately. When this does not happen right away, they begin to shout and threaten some of the other patients in the waiting area.
      What steps should you take in this situation?

      Your Answer: Ask the reception staff to call security

      Explanation:

      In a clinical setting, the prioritization of patient safety and the safety of staff members is crucial. Violence against other patients and health professionals is not tolerated. However, it is important to consider that the patient in question may be intoxicated or experiencing delirium tremens, which could impair their insight into their own behavior.

      To address this situation, it would be wise to call local security as a precautionary measure. This action can serve as a backup if additional assistance is required. However, involving the police at this stage may escalate the situation unnecessarily and potentially agitate the patient further.

      Administering sedation to the patient without understanding their medical history or gathering more information would not be appropriate. It is essential to have a comprehensive understanding of the patient’s condition before considering any interventions.

      Similarly, asking the patient to leave the department immediately could potentially worsen the situation. It is important to approach the situation with caution and consider alternative strategies to de-escalate the situation effectively.

    • This question is part of the following fields:

      • Mental Health
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  • Question 23 - A 25-year-old female patient has presented to the Emergency Department intoxicated on multiple...

    Correct

    • A 25-year-old female patient has presented to the Emergency Department intoxicated on multiple occasions over the past few weeks. Throughout this period, she has experienced various minor injuries. You would like to screen her for alcohol misuse.
      What is the MOST SUITABLE course of action in this scenario?

      Your Answer: Use CAGE tool

      Explanation:

      CAGE, AUDIT, and T-ACE are all tools used to screen for alcohol misuse. The CAGE tool is the most commonly used by clinicians and consists of four simple questions. It is easy to remember and effective in identifying potential alcohol-related issues. The CAGE questionnaire asks if the individual has ever felt the need to cut down on their drinking, if others have criticized their drinking, if they have felt guilty about their drinking, and if they have ever had a drink first thing in the morning to alleviate a hangover or calm their nerves. A score of 2 or 3 suggests a high likelihood of alcoholism, while a score of 4 is almost diagnostic.

      T-ACE is specifically designed to screen for alcohol abuse in pregnant women. It helps identify potential issues and allows for appropriate intervention and support.

      The AUDIT tool is a more comprehensive questionnaire consisting of 10 points. It is typically used after initial screening and provides a more detailed assessment of alcohol consumption and potential dependency. The AUDIT-C, a simplified version of the AUDIT tool, is often used in primary care settings. It consists of three questions and is a quick and effective way to assess alcohol-related concerns.

      While asking patients about their alcohol intake can provide some insight into excessive drinking, the screening tools are specifically designed to assess alcohol dependence and hazardous drinking. They offer a more comprehensive evaluation and help healthcare professionals identify individuals who may require further intervention or support.

      It is important to note that advising patients on the harmful effects of alcohol is a valuable component of brief interventions. However, it is not as effective as using screening tools to identify potential alcohol-related issues.

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      • Mental Health
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  • Question 24 - A 45-year-old patient arrives at the Emergency Department complaining of a severe headache....

    Correct

    • A 45-year-old patient arrives at the Emergency Department complaining of a severe headache. This individual is a known heavy drinker, consuming 15-20 units of alcohol daily. It is currently 3 pm, and the patient is visibly intoxicated. Despite the need for assessment, the patient adamantly refuses and insists on leaving.
      What course of action would be most suitable in this situation?

      Your Answer: Suggest a referral to the community drug and alcohol team

      Explanation:

      When considering the management of long-term conditions and promoting patient self-care, it is important to explore various factors. However, out of the given options, the only safe and viable choice is to refer the patient to the community drug and alcohol team. Without further information about the patient’s headache, a CT scan is not necessary. It would be unwise to advise the patient to stop drinking or to allow them to leave the department without assessing their capacity and obtaining their signature on a self-discharge form. At this point, there is insufficient information to make a referral to the medical team.

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      • Mental Health
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  • Question 25 - A 35-year-old man is admitted to the Clinical Decision Unit (CDU) in the...

    Incorrect

    • A 35-year-old man is admitted to the Clinical Decision Unit (CDU) in the early hours of the morning. He was brought in by the police as he’d been causing a disturbance in the street. They were concerned that he might have medical issues that need reviewing. He is well known to the department and has a long history of multiple attendances, usually related to substance abuse. He appeared intoxicated on admission, and the decision was made to observe him overnight. He is now fully alert and orientated, and is very apologetic about his behavior the previous night. He does not want to wait to be reviewed by the doctors and wants to go home.
      What is the best course of action for you to take? Select ONE option only.

      Your Answer: Offer her some IV fluids and nutritional advice before you discharge her

      Correct Answer: Refer the patient for follow up in the community by the alcohol outreach team

      Explanation:

      This question is assessing various aspects, such as your ability to make decisions, manage long-term conditions, and promote patient self-care.

      The most appropriate action would be to get in touch with the community alcohol outreach team to ensure that the patient receives proper follow-up care. Additionally, it is important to assess the patient’s Glasgow Coma Scale (GCS) before considering self-discharge. However, this does not indicate the need for long-term follow-up.

      Asking a family member to monitor the patient is not a safe or suitable solution, and providing intravenous fluids and nutritional advice does not address the underlying long-term issues in this case. It would be potentially dangerous to suggest that the patient stops drinking immediately.

      Overall, contacting the community alcohol outreach team for follow-up care is the best course of action in this situation.

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      • Mental Health
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  • Question 26 - A 45-year-old combat veteran, Sarah, has been diagnosed with post-traumatic stress disorder (PTSD).
    What...

    Correct

    • A 45-year-old combat veteran, Sarah, has been diagnosed with post-traumatic stress disorder (PTSD).
      What is the most suitable treatment for her?

      Your Answer: Eye Movement Desensitisation and Reprocessing

      Explanation:

      Eye movement desensitization and reprocessing (EMDR) and trauma-focused cognitive-behavioral therapy (CBT) are the primary treatment options for post-traumatic stress disorder (PTSD). These therapies should be provided to individuals of all ages, including children, adolescents, and adults, regardless of the time that has passed since the traumatic event. The recommended number of sessions is typically 8-12, although additional sessions may be necessary in cases involving multiple traumas, chronic disability, comorbidities, or social difficulties.

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      • Mental Health
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  • Question 27 - A 35-year-old man is involved in a car crash in which his wife...

    Incorrect

    • A 35-year-old man is involved in a car crash in which his wife is killed. He is uninjured and was released from the hospital after an evaluation the same evening as the accident. He comes back three days later with significant symptoms of anxiety and difficulty remembering the details of the accident. He describes feeling out of it and disoriented. He also reports feeling emotionally detached from the events at this point.

      What is the SINGLE most probable diagnosis?

      Your Answer: Post-traumatic stress disorder

      Correct Answer: Acute stress disorder

      Explanation:

      This woman has been exposed to a highly traumatic event that likely caused intense fear and helplessness. She also witnessed the shocking death of her spouse. As a result, it is highly likely that she will develop acute stress disorder.

      Common features of acute stress disorder include a subjective feeling of detachment and a lack of emotional responsiveness. Individuals may also experience a reduction in awareness of their surroundings, often described as being in a daze. Additionally, derealization and depersonalization may occur, where individuals feel disconnected from reality or their own sense of self.

      Another symptom of acute stress disorder is dissociative amnesia, where individuals have difficulty remembering the traumatic events. They may also experience flashbacks and dreams about the event, which can be distressing and intrusive. Symptoms of anxiety or increased arousal, such as restlessness or hypervigilance, are also common.

      Typically, acute stress disorder lasts between two days and four weeks after the traumatic event. It is important to note that it usually occurs within four weeks of the traumatic event.

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      • Mental Health
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  • Question 28 - A young man presents to the Emergency Department with symptoms of acute alcohol...

    Incorrect

    • A young man presents to the Emergency Department with symptoms of acute alcohol withdrawal. He is requesting admission for ‘inpatient detox’ and states he would like some ‘medication to alleviate his symptoms’.
      Which of the following is NOT a reason for admitting this patient?

      Your Answer: Multiple comorbidities

      Correct Answer: Previous successful inpatient detox

      Explanation:

      NICE provides a list of reasons for admitting patients with acute alcohol withdrawal. These include individuals who are deemed to be at risk of experiencing withdrawal seizures or delirium tremens. Additionally, young people under the age of 16 who are going through acute alcohol withdrawal may also require admission. Furthermore, vulnerable individuals, such as those who are frail, have cognitive impairment or multiple comorbidities, lack social support, or have learning difficulties, may also benefit from being admitted for acute alcohol withdrawal. For more information, please refer to the NICE pathway for acute alcohol withdrawal.

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      • Mental Health
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  • Question 29 - You assess a 30-year-old woman with a history of bipolar disorder and previous...

    Incorrect

    • You assess a 30-year-old woman with a history of bipolar disorder and previous episodes of self-harm and suicidal behavior.
      Which ONE of the following factors has NOT been demonstrated to elevate the likelihood of violence?

      Your Answer: Low levels of self-care

      Correct Answer: Anxiety disorder

      Explanation:

      Anxiety disorder does not have a connection with a higher likelihood of engaging in violent behavior. However, there are several factors that are acknowledged to increase the risk of violence among patients. These factors include being male, being young (under 40 years old), having poor levels of self-care, exhibiting coercive behavior, having a history of previous violent episodes, making multiple visits to the hospital, being intoxicated with alcohol, and experiencing organic psychosis.

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      • Mental Health
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  • Question 30 - A 25-year-old woman with a history of schizophrenia is brought to the Emergency...

    Incorrect

    • A 25-year-old woman with a history of schizophrenia is brought to the Emergency Department. She is exhibiting signs of acute psychosis.
      Which ONE of the following is acknowledged as a negative symptom of schizophrenia?

      Your Answer: Thought broadcast

      Correct Answer: Blunted affect

      Explanation:

      The first-rank symptoms of schizophrenia, as described by Kurt Schneider, include auditory hallucinations such as hearing 3rd person voices discussing the patient, experiencing thought echo, and receiving commentary on one’s actions. Additionally, passivity phenomena may occur, such as thought insertion, thought withdrawal, thought broadcast, and feelings of thoughts and actions being under external control. Delusions, which can be primary or secondary, are also common in schizophrenia.

      On the other hand, chronic schizophrenia is characterized by negative symptoms. These include poor motivation and self-care, social withdrawal, depression, flat and blunted affect, emotional incongruity, decreased activity, and poverty of thought and speech. These symptoms are often present in individuals with chronic schizophrenia.

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      • Mental Health
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SESSION STATS - PERFORMANCE PER SPECIALTY

Mental Health (10/30) 33%
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