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  • Question 1 - A 19-year-old long-distance runner who is currently preparing for a regional marathon seeks...

    Incorrect

    • A 19-year-old long-distance runner who is currently preparing for a regional marathon seeks an appointment with the team doctor due to an unusual sensation in her legs. She reports feeling numbness below her knee. During the examination, the doctor observes sensory loss below the left knee in a non-dermatomal distribution. The team doctor suspects a non-organic cause of her symptoms. What type of disorder is this an example of?

      Your Answer: Somatisation disorder

      Correct Answer: Conversion disorder

      Explanation:

      Conversion disorder is a condition that often results in the loss of motor or sensory function and is believed to be triggered by stress.

      Psychiatric Terms for Unexplained Symptoms

      There are various psychiatric terms used to describe patients who exhibit symptoms for which no organic cause can be found. One such disorder is somatisation disorder, which involves the presence of multiple physical symptoms for at least two years, and the patient’s refusal to accept reassurance or negative test results. Another disorder is illness anxiety disorder, which is characterized by a persistent belief in the presence of an underlying serious disease, such as cancer, despite negative test results.

      Conversion disorder is another condition that involves the loss of motor or sensory function, and the patient does not consciously feign the symptoms or seek material gain. Patients with this disorder may be indifferent to their apparent disorder, a phenomenon known as la belle indifference. Dissociative disorder, on the other hand, involves the process of ‘separating off’ certain memories from normal consciousness, and may manifest as amnesia, fugue, or stupor. Dissociative identity disorder (DID) is the most severe form of dissociative disorder and was previously known as multiple personality disorder.

      Factitious disorder, also known as Munchausen’s syndrome, involves the intentional production of physical or psychological symptoms. Finally, malingering is the fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain. Understanding these psychiatric terms can help healthcare professionals better diagnose and treat patients with unexplained symptoms.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 2 - You are evaluating a 23-year-old man who reports experiencing auditory hallucinations that have...

    Correct

    • You are evaluating a 23-year-old man who reports experiencing auditory hallucinations that have been occurring more frequently, now happening every day. Based on his history, which of the following factors is the most significant risk factor for psychotic disorders?

      Your Answer: Having a parent with schizophrenia

      Explanation:

      The most significant risk factor for psychotic disorders is a person’s family history.

      Understanding the Epidemiology of Schizophrenia

      Schizophrenia is a psychotic disorder that affects a significant portion of the population. The strongest risk factor for developing this condition is having a family history of the disorder. Individuals with a parent who has schizophrenia have a relative risk of 7.5. Additionally, monozygotic twins have a 50% chance of developing schizophrenia, while siblings have a 10% chance. In contrast, individuals with no relatives with schizophrenia have a 1% chance of developing the disorder.

      Aside from family history, other factors can increase the risk of developing schizophrenia. Black Caribbean ethnicity has a relative risk of 5.4, while migration and living in an urban environment have relative risks of 2.9 and 2.4, respectively. Cannabis use also increases the risk of developing schizophrenia, with a relative risk of 1.4.

      Understanding the epidemiology of schizophrenia is crucial in identifying individuals who may be at risk of developing the disorder. By recognizing these risk factors, healthcare professionals can provide early interventions and support to prevent or manage the onset of schizophrenia.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 3 - The Medicines and Healthcare products Regulatory Agency has cautioned that which category of...

    Correct

    • The Medicines and Healthcare products Regulatory Agency has cautioned that which category of medication may be linked to a higher incidence of venous thromboembolism in older individuals?

      Your Answer: Atypical antipsychotics

      Explanation:

      Elderly individuals taking antipsychotics are at a higher risk of experiencing stroke and VTE.

      Antipsychotics are a group of drugs 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. They are associated with extrapyramidal side-effects and hyperprolactinaemia, which are less common with atypical antipsychotics.

      Extrapyramidal side-effects (EPSEs) are common with typical antipsychotics and include Parkinsonism, acute dystonia, sustained muscle contraction, akathisia, and tardive dyskinesia. The latter is a late onset of choreoathetoid movements that may be irreversible and occur in 40% of patients. The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients, including an increased risk of stroke and venous thromboembolism. Other side-effects include antimuscarinic effects, sedation, weight gain, raised prolactin, impaired glucose tolerance, neuroleptic malignant syndrome, reduced seizure threshold, and prolonged QT interval.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 4 - A 10-year-old boy has been referred due to unusual behaviour at school. His...

    Incorrect

    • A 10-year-old boy has been referred due to unusual behaviour at school. His teachers have reported that he displays both passive and aggressive behaviours. Sometimes, he becomes withdrawn and cries when he feels he has been mistreated. Other times, he becomes very angry and fights over minor issues. Upon further investigation, it is revealed that the patient has experienced significant abuse at home.
      What defence mechanism is he likely using?

      Your Answer: Splitting

      Correct Answer: Dissociation

      Explanation:

      Understanding Ego Defense Mechanisms: Differentiating Dissociation from Other Defenses

      Ego defense mechanisms are psychological strategies that individuals use to cope with stressful situations. One of these mechanisms is dissociation, which involves a temporary modification of one’s personal identity to avoid distress. However, it is important to differentiate dissociation from other defense mechanisms to better understand the patient’s behavior.

      Reaction formation is another defense mechanism where unacceptable emotions are repressed and replaced by their opposite. This is not the case with the patient in question, as their behavior is not consistently opposite to their true feelings.

      Identification is when someone models the behavior of a more powerful person. This could explain why a victim of child abuse may become an abuser in adulthood. However, the patient’s behavior is not consistently modeled after another person.

      Splitting is a defense mechanism where individuals cannot reconcile both good and bad traits in a person, leading them to see people as either all good or all bad. This is not present in the patient’s behavior.

      Finally, sublimation is a mature defense mechanism where individuals take an unacceptable trait and use it to drive a respectable work that aligns with their values. This is not relevant to the patient’s behavior.

      In conclusion, dissociation is a unique defense mechanism that involves a drastic modification of personal identity to avoid distress. Understanding the differences between dissociation and other defense mechanisms can help clinicians better diagnose and treat patients.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 5 - A 67-year-old male with metastatic prostate cancer is seen in clinic. His wife...

    Correct

    • A 67-year-old male with metastatic prostate cancer is seen in clinic. His wife reports that he has been experiencing confusion and occasionally talks to people who are not present. Despite investigations for reversible causes, no underlying issues are found. If conservative measures prove ineffective and he continues to exhibit confusion and agitation, what is the most suitable course of action?

      Your Answer: Oral haloperidol

      Explanation:

      Palliative Care Prescribing for Agitation and Confusion

      When dealing with agitation and confusion in palliative care patients, it is important to identify and treat any underlying causes such as hypercalcaemia, infection, urinary retention, or medication. If these specific treatments fail, medication can be used to manage symptoms. Haloperidol is the first choice for treating agitation and confusion, with chlorpromazine and levomepromazine as alternative options. In the terminal phase of the illness, midazolam is the preferred medication for managing agitation or restlessness. Proper management of these symptoms can greatly improve the quality of life for palliative care patients.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 6 - A 30-year-old man visits his doctor's office with complaints of difficulty sleeping. Upon...

    Correct

    • A 30-year-old man visits his doctor's office with complaints of difficulty sleeping. Upon further inquiry, he reveals that he avoids social situations due to a fear of being judged, and experienced a panic attack with rapid heart rate and shortness of breath while at a movie theater a few weeks ago.
      What is the most probable diagnosis?

      Your Answer: Social phobia

      Explanation:

      Differentiating Social Phobia from Other Anxiety Disorders

      Social phobia, also known as social anxiety disorder, is a type of anxiety disorder characterized by intense fear and anxiety in social situations, particularly when being scrutinized. It typically starts in adolescence and affects both men and women equally. Some individuals may have a specific fear of certain situations, while others may experience anxiety in most social situations outside of close family and friends. Low self-esteem is often associated with social phobia, and avoidance of feared situations is common. Treatment typically involves psychological interventions such as cognitive-behavioral therapy.

      It is important to differentiate social phobia from other anxiety disorders. Panic disorder is characterized by recurrent episodes of severe anxiety that occur unpredictably and without an objective danger. Agoraphobia involves a fear of situations where escape to a safe place is difficult or impossible. Generalized anxiety disorder is characterized by non-specific and persistent anxiety, often accompanied by autonomic and motor overactivity. Depression may also be associated with anxiety, but typically involves early morning waking rather than difficulty falling asleep.

      By understanding the specific features of social phobia and how it differs from other anxiety disorders, healthcare professionals can provide appropriate diagnosis and treatment for their patients.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 7 - Which of the following is linked to a favorable prognosis in individuals with...

    Correct

    • Which of the following is linked to a favorable prognosis in individuals with schizophrenia?

      Your Answer: Acute onset

      Explanation:

      A poor prognosis is often linked to a gradual onset rather than an acute one.

      Schizophrenia is a mental disorder that can have varying prognoses depending on certain factors. Some indicators associated with a poor prognosis include a strong family history of the disorder, a gradual onset of symptoms, a low IQ, a prodromal phase of social withdrawal, and a lack of an obvious precipitant. These factors can contribute to a more severe and chronic course of the illness, making it more difficult to manage and treat. It is important for individuals with schizophrenia and their loved ones to be aware of these indicators and seek appropriate treatment and support.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 8 - A 16-year-old is brought to her General Practitioner by her parents after they...

    Correct

    • A 16-year-old is brought to her General Practitioner by her parents after they noticed her eating habits had become irregular. The parents report that the patient eats large volumes of foods and is sometimes found vomiting shortly after eating dinner. This behaviour has been occurring for the past six months.
      On examination, the patient’s vital signs are normal and she has a body mass index body mass index (BMI) of 23 kg/m2. She has excoriations on the knuckles of her right hand. She also has erosions on her teeth and swelling bilaterally on the lateral aspects of the face along the mandibular rami.
      What is the most likely diagnosis?

      Your Answer: Bulimia nervosa

      Explanation:

      Common Mental Health Disorders: Symptoms and Characteristics

      Bulimia Nervosa
      Bulimia nervosa is an eating disorder characterized by binge eating followed by purging, usually in the form of vomiting. Patients with bulimia nervosa tend to have normal BMI despite purging behavior. Symptoms include teeth erosion, swelling along the mandibular rami (parotitis), and excoriations of the knuckles (Russell’s sign).

      Gender Dysphoria
      Gender dysphoria is a condition where an individual experiences a strong identification with a gender other than that assigned at birth. This can be managed through social or medical transition, such as hormone or surgical treatments that are gender-affirming.

      Anorexia Nervosa
      Anorexia nervosa is characterized by decreased dietary intake with or without purging behavior. Patients with anorexia nervosa tend to have extremely low BMI due to low calorie intake. Symptoms include early osteoporosis and electrolyte abnormalities due to malnutrition.

      Avoidant Personality Disorder
      Avoidant personality disorder is characterized by a person who wishes to have friends and social outlets but is so shy that they are unable to form relationships out of fear of rejection. This is different from the schizoid personality, which prefers to be alone.

      Binge Eating Disorder
      Binge eating disorder is characterized by purely binge eating without purging behavior. Symptoms include distress and weight gain.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 9 - A 17-year-old girl presents to her General Practitioner (GP) with a 3-year history...

    Incorrect

    • A 17-year-old girl presents to her General Practitioner (GP) with a 3-year history of restricting food intake weight loss and excessive exercise. She attends her GP for the first time with her sibling reporting a recent worsening of her symptoms. The GP suspects anorexia nervosa.
      Which is the most appropriate investigation to determine whether the patient requires urgent hospital admission?

      Your Answer: Transthoracic echocardiography

      Correct Answer: Electrocardiogram (ECG)

      Explanation:

      Medical Investigations for Anorexia Nervosa: Which Ones Are Necessary?

      When assessing a patient with anorexia nervosa, certain medical investigations may be necessary to evaluate their overall health and identify any potential complications. However, not all investigations are routinely required. Here is a breakdown of some common investigations and when they may be necessary:

      Electrocardiogram (ECG): A baseline ECG is important to assess for any cardiovascular instability, including heart rate and QT interval. Electrolyte abnormalities from eating disorders can impact cardiac stability.

      24-hour Holter monitor: This investigation may be considered if there is a problem with the baseline ECG or a history of cardiac symptoms such as palpitations.

      Chest X-ray (CXR): A CXR is not routinely required unless there is clinical concern of other respiratory symptoms.

      Serum prolactin: This investigation is not routinely required unless there is a history of galactorrhoea or amenorrhoea.

      Transthoracic echocardiography: This investigation is not routinely required unless there is a clinical history or examination findings to suggest imaging of the heart is required.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 10 - A 25-year-old woman is brought into the emergency department by the police after...

    Correct

    • A 25-year-old woman is brought into the emergency department by the police after being arrested in a local bar for odd and aggressive behaviour. Whilst taking a history she tells you that she can't understand why she has been arrested as she was just celebrating the fact that she has recently figured out how to solve world hunger and she wants to share this with everyone. You struggle to keep up with her pace of speech and throughout the consultation, she is aggressive and at times sexually inappropriate. An initial drug screen is clear and her bloods are unremarkable.
      What is the most likely cause of her behaviour?

      Your Answer: Manic episode

      Explanation:

      The woman is exhibiting clear indications of a manic episode, including rapid speech, uninhibited behavior, and grandiose delusions. Tests for drugs and alcohol have ruled out intoxication or drug-induced psychosis. Schizophrenia is unlikely as a first-time diagnosis, and the symptoms suggest mania or bipolar disorder. However, a diagnosis of bipolar disorder cannot be made without evidence of depressive symptoms. Therefore, the correct diagnosis in this case is an isolated manic episode of unknown origin.

      Understanding the Difference between Hypomania and Mania

      Hypomania and mania are two terms that are often used interchangeably, but they actually refer to two different conditions. While both conditions share some common symptoms, there are some key differences that set them apart.

      Mania is a more severe form of hypomania that lasts for at least seven days and can cause significant impairment in social and work settings. It may require hospitalization due to the risk of harm to oneself or others and may present with psychotic symptoms such as delusions of grandeur or auditory hallucinations.

      On the other hand, hypomania is a lesser version of mania that lasts for less than seven days, typically 3-4 days. It does not impair functional capacity in social or work settings and is unlikely to require hospitalization. It also does not exhibit any psychotic symptoms.

      Both hypomania and mania share common symptoms such as elevated or irritable mood, pressured speech, flight of ideas, poor attention, insomnia, loss of inhibitions, increased appetite, and risk-taking behavior. However, the length of symptoms, severity, and presence of psychotic symptoms help differentiate mania from hypomania.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 11 - A 60-year-old man with a 20-year history of treatment with antipsychotic medications for...

    Correct

    • A 60-year-old man with a 20-year history of treatment with antipsychotic medications for bipolar disorder complains of the onset of writhing tongue and finger movements.
      Which of the following is the most likely cause?

      Your Answer: Tardive dyskinesia

      Explanation:

      Understanding Movement Disorders Associated with Anti-Psychotic Medication

      Anti-psychotic medication can cause a range of movement disorders, including tardive dyskinesia, akathisia, and Parkinsonism. Tardive dyskinesia is a common side-effect of long-term treatment with anti-psychotics, but can also occur with minimal doses. It is characterized by choreoathetoid movements, often starting in the fingers and tongue and becoming more generalized. Treatment is often unsuccessful, but may involve switching to a different medication or using agents such as tetrabenazine or benzodiazepines. Akathisia is an inner feeling of motor restlessness, with voluntary movements such as pacing or rocking. Parkinsonism is characterized by resting tremor, rigidity, and bradykinesia. These movement disorders can be mistaken for other conditions such as Huntington’s or Wilson’s disease, but the association with anti-psychotic medication and the specific symptoms make tardive dyskinesia a more likely option. It is important for healthcare professionals to monitor patients on anti-psychotic medication for these potential side-effects and adjust treatment as necessary.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 12 - A 50-year-old man with schizophrenia who is on chlorpromazine experiences an oculogyric crisis....

    Correct

    • A 50-year-old man with schizophrenia who is on chlorpromazine experiences an oculogyric crisis. Which side effect of antipsychotic medication does this exemplify?

      Your Answer: Acute dystonia

      Explanation:

      Antipsychotics are a group of drugs 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. They are associated with extrapyramidal side-effects and hyperprolactinaemia, which are less common with atypical antipsychotics.

      Extrapyramidal side-effects (EPSEs) are common with typical antipsychotics and include Parkinsonism, acute dystonia, sustained muscle contraction, akathisia, and tardive dyskinesia. The latter is a late onset of choreoathetoid movements that may be irreversible and occur in 40% of patients. The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients, including an increased risk of stroke and venous thromboembolism. Other side-effects include antimuscarinic effects, sedation, weight gain, raised prolactin, impaired glucose tolerance, neuroleptic malignant syndrome, reduced seizure threshold, and prolonged QT interval.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 13 - You are on a GP placement and seeing a 44-year-old woman with a...

    Correct

    • You are on a GP placement and seeing a 44-year-old woman with a history of depression. She has recently gone through a divorce and admits to having thoughts of taking an overdose. She has never attempted suicide before, but feels like she has no other options. She has the pills at home and is considering taking them. She denies any substance abuse. What is the appropriate course of action in this situation?

      Your Answer: Speak to the CRISIS team

      Explanation:

      This scenario requires you to demonstrate your ability to evaluate and handle a patient who is contemplating suicide. The patient in question has several risk factors, including being male, having a history of depression, recently going through a separation, and expressing a desire to end his life in the future. It is crucial to respond appropriately in this situation. The most suitable team to evaluate and manage this patient is the CRISIS team, who can provide urgent assessment and care.

      The other options are not as effective. Transferring the patient to the Emergency Department would only delay the referral to the crisis team. CAMH, which stands for child and adolescent mental health, is not the appropriate team to handle this case. It is not within your professional scope to initiate relationship counseling. Given the patient’s numerous risk factors, it would not be safe to discharge him without a psychiatric evaluation.

      In 2022, NICE updated its guidelines on managing depression and now classifies it as either less severe or more severe based on a patient’s PHQ-9 score. For less severe depression, NICE recommends discussing treatment options with patients and considering the least intrusive and resource-intensive treatment first. Antidepressant medication should not be routinely offered as first-line treatment unless it is the patient’s preference. Treatment options for less severe depression include guided self-help, group cognitive behavioral therapy, group behavioral activation, individual CBT or BA, group exercise, group mindfulness and meditation, interpersonal psychotherapy, SSRIs, counseling, and short-term psychodynamic psychotherapy. For more severe depression, NICE recommends a shared decision-making approach and suggests a combination of individual CBT and an antidepressant as the preferred treatment option. Other treatment options for more severe depression include individual CBT or BA, antidepressant medication, individual problem-solving, counseling, short-term psychodynamic psychotherapy, interpersonal psychotherapy, guided self-help, and group exercise.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 14 - A 65-year-old man is prescribed amitriptyline for his neuropathic pain. After ten days,...

    Incorrect

    • A 65-year-old man is prescribed amitriptyline for his neuropathic pain. After ten days, he reports experiencing frequent urinary leakage. Which type of urinary incontinence is most commonly associated with amitriptyline use?

      Your Answer: Functional incontinence

      Correct Answer: Overflow incontinence

      Explanation:

      Overflow incontinence can be caused by tricyclic antidepressants due to their anticholinergic effects.

      The drug class of tricyclic antidepressants, which includes Amitriptyline, can lead to urinary retention and frequent leaking due to their anticholinergic effects. Antimuscarinic drugs can be used to treat urge incontinence, which is caused by detrusor over-activity, while stress incontinence, which occurs when the bladder is under pressure, can result in urine leakage when coughing or laughing.

      Tricyclic Antidepressants for Neuropathic Pain

      Tricyclic antidepressants (TCAs) were once commonly used for depression, but their side-effects and toxicity in overdose have led to a decrease in their use. However, they are still widely used in the treatment of neuropathic pain, where smaller doses are typically required. TCAs such as low-dose amitriptyline are commonly used for the management of neuropathic pain and the prophylaxis of headache, while lofepramine has a lower incidence of toxicity in overdose. It is important to note that some TCAs, such as amitriptyline and dosulepin, are considered more dangerous in overdose than others.

      Common side-effects of TCAs include drowsiness, dry mouth, blurred vision, constipation, urinary retention, and lengthening of the QT interval. When choosing a TCA for neuropathic pain, the level of sedation may also be a consideration. Amitriptyline, clomipramine, dosulepin, and trazodone are more sedative, while imipramine, lofepramine, and nortriptyline are less sedative. It is important to work with a healthcare provider to determine the appropriate TCA and dosage for the individual’s specific needs.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 15 - As a side-effect, which antidepressants cause the cheese effect (a hypertensive reaction)?

    ...

    Incorrect

    • As a side-effect, which antidepressants cause the cheese effect (a hypertensive reaction)?

      Your Answer: Selective serotonin-reuptake inhibitors (SSRIs)

      Correct Answer: Monoamine oxidase inhibitors (MAOIs)

      Explanation:

      Differential Diagnosis: Jaundice and Abdominal Symptoms

      Gilbert Syndrome:
      Gilbert syndrome is an inherited condition that can manifest as jaundice on clinical examination. Patients may also experience non-specific symptoms such as abdominal cramps, fatigue, and malaise. Fasting, febrile illness, alcohol, or exercise can exacerbate jaundice in patients with Gilbert syndrome. Diagnosis is based on a thorough history and physical examination, as well as blood tests that show unconjugated hyperbilirubinaemia.

      Haemolytic Anaemia:
      Haemolysis is the premature destruction of erythrocytes, which can lead to anaemia if bone marrow activity cannot compensate for erythrocyte loss. Mild haemolysis can be asymptomatic, while severe haemolysis can cause life-threatening symptoms such as angina and cardiopulmonary decompensation. Changes in lactate dehydrogenase and serum haptoglobin levels are the most sensitive general tests for haemolytic anaemia.

      Hepatitis A:
      Hepatitis A is a viral infection that results almost exclusively from ingestion, typically through faecal-oral transmission. Symptoms include fatigue, anorexia, nausea, and vomiting. LFT abnormalities are common, and diagnosis is based on serologic testing for immunoglobulin M (IgM) antibody to HAV.

      Hepatitis B:
      Hepatitis B is a viral infection that is transmitted haematogenously and sexually. Symptoms include fatigue, anorexia, nausea, and vomiting. LFT abnormalities are common, and diagnosis is based on serologic testing for hepatitis B surface antigen (HBsAg).

      Cholecystitis:
      Cholecystitis is inflammation of the gall bladder that occurs most commonly because of an obstruction of the cystic duct by gallstones arising from the gall bladder. Symptoms include upper abdominal pain, nausea, vomiting, and fever. Signs of peritoneal irritation may also be present.

      Conclusion:
      In summary, the differential diagnosis of jaundice and abdominal symptoms includes Gilbert syndrome, haemolytic anaemia, hepatitis A, hepatitis B, and cholecystitis. Diagnosis is based on a thorough history and physical examination, as well as blood tests and serologic testing as appropriate. Treatment

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      • Psychiatry
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  • Question 16 - Which one of the following regarding the FAST questionnaire for alcohol misuse is...

    Incorrect

    • Which one of the following regarding the FAST questionnaire for alcohol misuse is correct?

      Your Answer: The minimum score is 4

      Correct Answer: May be stopped after first question depending on the answer

      Explanation:

      Alcohol Problem Drinking: Detection and Assessment

      Alcohol problem drinking can have serious consequences on an individual’s health and well-being. Therefore, it is important to detect and assess problem drinking early on. Screening tools such as AUDIT, FAST, and CAGE can be used to identify individuals who may have hazardous or harmful alcohol consumption or alcohol dependence.

      AUDIT is a 10-item questionnaire that takes about 2-3 minutes to complete. It has been shown to be superior to CAGE and biochemical markers for predicting alcohol problems. A score of 8 or more in men, and 7 or more in women, indicates a strong likelihood of hazardous or harmful alcohol consumption. A score of 15 or more in men, and 13 or more in women, is likely to indicate alcohol dependence. AUDIT-C is an abbreviated form consisting of 3 questions.

      FAST is a 4-item questionnaire with a minimum score of 0 and a maximum score of 16. The score for hazardous drinking is 3 or more. Over 50% of people will be classified using just the first question, which asks how often the individual has had eight or more drinks on one occasion (or six or more drinks for women).

      CAGE is a well-known screening test, but recent research has questioned its value. Two or more positive answers are generally considered a ‘positive’ result. The questions ask if the individual has ever felt the need to cut down on their drinking, if people have annoyed them by criticizing their drinking, if they have ever felt guilty about their drinking, and if they have ever had a drink in the morning to get rid of a hangover.

      To diagnose alcohol dependence, the ICD-10 definition requires three or more of the following: compulsion to drink, difficulties controlling alcohol consumption, physiological withdrawal, tolerance to alcohol, neglect of alternative activities to drinking, and persistent use of alcohol despite evidence of harm.

      Overall, using screening tools and diagnostic criteria can help healthcare professionals identify individuals with alcohol problem drinking and provide appropriate interventions and support.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 17 - A 25-year-old football player comes to the GP clinic complaining of a loss...

    Correct

    • A 25-year-old football player comes to the GP clinic complaining of a loss of motor function in his left leg. He denies any specific injuries and has an important game next week that he's been anxious about. He enters the room using crutches. During the examination, it is found that he has 0/5 power in his left knee, ankle, and toes. The rest of the neurological and musculoskeletal examination is unremarkable. Blood tests and a lumbar MRI come back normal, making an organic cause for his symptoms unlikely. He is eager to know the reason behind his condition so that he can resume his training.
      What is the most probable cause of his symptoms?

      Your Answer: Conversion disorder

      Explanation:

      It is probable that the patient is experiencing conversion disorder, which is often triggered by stress and involves the loss of motor or sensory function. The potential grand final rugby game may have been the stressor in this case.

      Somatisation disorder is unlikely as it requires the presence of multiple physical symptoms for at least two years, whereas this patient has only one acute onset symptom. Dissociative disorder is also improbable as there are no evident psychiatric symptoms such as amnesia, stupor, or fugue. The patient remembers clearly that he has a football game and has not sustained any recent injuries.

      However, factitious disorder cannot be ruled out entirely. It is possible that the patient is feigning the symptom to avoid playing the game, but further investigation is necessary. The patient claims to be eager to return to playing, which does not support the notion of factitious disorder.

      Psychiatric Terms for Unexplained Symptoms

      There are various psychiatric terms used to describe patients who exhibit symptoms for which no organic cause can be found. One such disorder is somatisation disorder, which involves the presence of multiple physical symptoms for at least two years, and the patient’s refusal to accept reassurance or negative test results. Another disorder is illness anxiety disorder, which is characterized by a persistent belief in the presence of an underlying serious disease, such as cancer, despite negative test results.

      Conversion disorder is another condition that involves the loss of motor or sensory function, and the patient does not consciously feign the symptoms or seek material gain. Patients with this disorder may be indifferent to their apparent disorder, a phenomenon known as la belle indifference. Dissociative disorder, on the other hand, involves the process of ‘separating off’ certain memories from normal consciousness, and may manifest as amnesia, fugue, or stupor. Dissociative identity disorder (DID) is the most severe form of dissociative disorder and was previously known as multiple personality disorder.

      Factitious disorder, also known as Munchausen’s syndrome, involves the intentional production of physical or psychological symptoms. Finally, malingering is the fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain. Understanding these psychiatric terms can help healthcare professionals better diagnose and treat patients with unexplained symptoms.

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      • Psychiatry
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  • Question 18 - As a junior doctor in a community mental health team, you are attending...

    Correct

    • As a junior doctor in a community mental health team, you are attending to a 35-year-old woman who is suffering from moderate-severe depression. She often voices out intense suicidal ideations and has a history of intentional overdose. Which category of antidepressants is currently less utilized due to their high toxicity in overdose?

      Your Answer: Tricyclic antidepressants

      Explanation:

      Tricyclic antidepressants are not commonly used for depression anymore due to their high risk of causing dangerous overdose. Therefore, when selecting an antidepressant for a patient who is at high risk of overdose, it is important to choose a class of antidepressants that are less toxic if taken in excess. TCAs have a narrow therapeutic index, which means that even moderate doses can lead to severe cardiovascular and CNS toxicity. Complications of TCA overdose include prolonged hypotension, cardiac arrhythmias, and seizures, which can ultimately result in death due to cardiovascular collapse.

      Diagnosis of TCA overdose is typically made based on clinical presentation, and classic ECG changes may be observed, such as sinus tachycardia progressing to wide complex tachycardia and ventricular arrhythmias as the severity of intoxication increases. Treatment involves correcting acidosis, hypoxia, and electrolyte imbalances, as well as administering hypertonic sodium bicarbonate to improve conduction abnormalities and hypotension. Anti-arrhythmic drugs should generally be avoided, and benzodiazepines are the preferred treatment for seizures.

      Tricyclic Antidepressants for Neuropathic Pain

      Tricyclic antidepressants (TCAs) were once commonly used for depression, but their side-effects and toxicity in overdose have led to a decrease in their use. However, they are still widely used in the treatment of neuropathic pain, where smaller doses are typically required. TCAs such as low-dose amitriptyline are commonly used for the management of neuropathic pain and the prophylaxis of headache, while lofepramine has a lower incidence of toxicity in overdose. It is important to note that some TCAs, such as amitriptyline and dosulepin, are considered more dangerous in overdose than others.

      Common side-effects of TCAs include drowsiness, dry mouth, blurred vision, constipation, urinary retention, and lengthening of the QT interval. When choosing a TCA for neuropathic pain, the level of sedation may also be a consideration. Amitriptyline, clomipramine, dosulepin, and trazodone are more sedative, while imipramine, lofepramine, and nortriptyline are less sedative. It is important to work with a healthcare provider to determine the appropriate TCA and dosage for the individual’s specific needs.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 19 - A 29-year-old woman comes to see her GP due to feeling down and...

    Correct

    • A 29-year-old woman comes to see her GP due to feeling down and lonely. She reports being a naturally shy person and experiencing intense anxiety about being judged or rejected by others for her perceived inadequacies. This has led her to avoid forming close relationships and she has even stopped seeing the few friends she had. Her social anxiety affects all aspects of her life, including her choice of a solitary job, solo hobbies, and never having been in a romantic relationship. She finds it challenging to deviate from her limited daily routine, although she feels unfulfilled by it. What is the probable diagnosis?

      Your Answer: Avoidant personality disorder

      Explanation:

      The patient’s description of feeling lonely and avoiding social situations due to fear of negative evaluation and criticism suggests a diagnosis of avoidant personality disorder. This disorder is characterized by chronic patterns of interpersonal inhibition, fear of rejection, and social inhibition. The patient’s symptoms are pervasive and have been present since childhood or adolescence, indicating a personality disorder rather than a transient condition. While other disorders such as autism spectrum disorder, generalized anxiety disorder, and schizoid personality disorder may also involve social difficulties, they do not have the same fear of rejection and feelings of inadequacy that are characteristic of avoidant personality disorder.

      Personality disorders are a set of personality traits that are maladaptive and interfere with normal functioning in life. It is estimated that around 1 in 20 people have a personality disorder, which are typically categorized into three clusters: Cluster A, which includes Odd or Eccentric disorders such as Paranoid, Schizoid, and Schizotypal; Cluster B, which includes Dramatic, Emotional, or Erratic disorders such as Antisocial, Borderline (Emotionally Unstable), Histrionic, and Narcissistic; and Cluster C, which includes Anxious and Fearful disorders such as Obsessive-Compulsive, Avoidant, and Dependent.

      Paranoid individuals exhibit hypersensitivity and an unforgiving attitude when insulted, a reluctance to confide in others, and a preoccupation with conspirational beliefs and hidden meanings. Schizoid individuals show indifference to praise and criticism, a preference for solitary activities, and emotional coldness. Schizotypal individuals exhibit odd beliefs and magical thinking, unusual perceptual disturbances, and inappropriate affect. Antisocial individuals fail to conform to social norms, deceive others, and exhibit impulsiveness, irritability, and aggressiveness. Borderline individuals exhibit unstable interpersonal relationships, impulsivity, and affective instability. Histrionic individuals exhibit inappropriate sexual seductiveness, a need to be the center of attention, and self-dramatization. Narcissistic individuals exhibit a grandiose sense of self-importance, lack of empathy, and excessive need for admiration. Obsessive-compulsive individuals are occupied with details, rules, and organization to the point of hampering completion of tasks. Avoidant individuals avoid interpersonal contact due to fears of criticism or rejection, while dependent individuals have difficulty making decisions without excessive reassurance from others.

      Personality disorders are difficult to treat, but a number of approaches have been shown to help patients, including psychological therapies such as dialectical behavior therapy and treatment of any coexisting psychiatric conditions.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 20 - You are requested to evaluate a 27-year-old male who is currently admitted to...

    Incorrect

    • You are requested to evaluate a 27-year-old male who is currently admitted to an adult psychiatric ward.

      Upon asking him how he is feeling, his speech seems to be rapid and difficult to interrupt. It is challenging to follow his train of thought, although the content of each sentence appears to be loosely connected. He talks about having money, but says, I've got cash, dash for cash, dash of alcohol, thank you very much.

      It is suspected that he has a formal thought disorder.

      What is the best way to describe his presentation?

      Your Answer: Circumstantiality

      Correct Answer: Flight of ideas

      Explanation:

      Understanding the Difference between Hypomania and Mania

      Hypomania and mania are two terms that are often used interchangeably, but they actually refer to two different conditions. While both conditions share some common symptoms, there are some key differences that set them apart.

      Mania is a more severe form of hypomania that lasts for at least seven days and can cause significant impairment in social and work settings. It may require hospitalization due to the risk of harm to oneself or others and may present with psychotic symptoms such as delusions of grandeur or auditory hallucinations.

      On the other hand, hypomania is a lesser version of mania that lasts for less than seven days, typically 3-4 days. It does not impair functional capacity in social or work settings and is unlikely to require hospitalization. It also does not exhibit any psychotic symptoms.

      Both hypomania and mania share common symptoms such as elevated or irritable mood, pressured speech, flight of ideas, poor attention, insomnia, loss of inhibitions, increased appetite, and risk-taking behavior. However, the length of symptoms, severity, and presence of psychotic symptoms help differentiate mania from hypomania.

    • This question is part of the following fields:

      • Psychiatry
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