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Examination Practice: Psychiatry
Question 1 of 66
A 17-year-old female is referred with a six month history of amenorrhoea and
weight loss, for which no organic cause can be found. Which of the following
features would support a diagnosis of anorexia nervosa?
Available marks are shown in brackets
1 ) Delusions of poisoning [0]
2 ) Hypotrichosis [0]
3 ) Hypergonadotrophic hypogonadism [0]
4 ) Delsuion of being overweight [100]
5 ) Watery diarrhoea [0]
Comments:
Features of AN include a phobic avoidance of normal weight, relentless dieting,
selfinduced vomiting, laxative use, excessive exercise, amenorrhoea, lanugo hair,
hypotension, denial, concealment, overperception of body image, enmeshed families.
Question 2 of 66
A 17-year-old student presented with recurrent attacks of dizziness.
Which one of the following additional features is most suggestive that she has an
anxiety disorder?
Available marks are shown in brackets
1 ) elevated diastolic blood pressure [0]
2 ) nocturia [0]
3 ) paraesthesiae in the hands [100]
4 ) rotational vertigo [0]
5 ) tinnitus [0]
Comments:
Paraesthesia is often experienced with hyperventilation associated with anxiety
disorders and is often in hands, feet and peri-orally. Rotational vertigo and tinnitus
suggest an organic disorder, whilst anxiety disorder may be associated with raised
systolic blood pressure
Question 3 of 66
A 22-year-old woman presented following an overdose. She had had an argument
with her boyfriend and had then driven to an isolated country lane where she had
swallowed 20 Paracetamol tablets and a bottle of wine.
Which one of the following is the strongest predictor that she may later make a fatal
suicide attempt?
Available marks are shown in brackets
1 ) Female gender [0]
2 ) Location of the suicide attempt [100]
3 ) Taking alcohol with the tablets [0]
4 ) The argument with the boyfriend [0]
5 ) The number of tablets [0]
Comments:
About one-third of people who attempt suicide will repeat the attempt within one
year, and about 10% of those who threaten or attempt suicide eventually do kill
themselves.
There are certain characteristics that have been found in those who are more likely to
repeat an attempted suicide.
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,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~)!@!@@
ych_exam.doc@@@@@@@@@@@@!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
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These characteristics include: age of 45 or more; the fact of being male; a previous
attempt which resulted in hospital admission; problems with drugs or alcohol;
suffering from a personality disorder; living alone (especially if separated, divorced,
or widowed); previous history of psychiatric treatment, criminal record,
unemployment and lower social class. Relational pathology, for example an ongoing
difficulty with her relationship with her boyfriend, is also a recognised factor for
repeat suicide attempts. The fact that we do not know whether she has ongoing
relationship problems means that we can not class this as the strongest predictor of
future suicidal intent.
Thus, the fact that she drove to an isolated area, where there was little chance of her
being found, suggests that this is a serious attempt at suicide, which predicts future
suicidal intent
Question 5 of 66
A 63-year-old man was found collapsed. A Department of Psychiatry outpatient
Card was found in his jacket, together with a bottle of procyclidine tablets. He was
febrile (38.2°C), conscious but unresponsive to commands. The blood pressure was
160/105 mmHg and there was marked muscle rigidity.
What is the most likely diagnosis?
Available marks are shown in brackets
1 ) acute catatonic schizophrenia [0]
2 ) bacterial meningitis [0]
3 ) cerebral malaria [0]
4 ) neuroleptic malignant syndrome [100]
5 ) procyclidine overdose [0]
Comments:
The symptoms are typical of neuroleptic malignant syndrome (NMS). NMS is
characterized by fever, muscular rigidity, altered mental status, and autonomic
dysfunction. Procyclidine is used to treat the Parkinsonian side-effects of
neuroleptics:
its presence in the patient's pocket implies that he was taking neuroleptics. Signs of
procyclidine overdose include agitation, confusion, and sleeplessness lasting up to 24
hours or more. Pupils are dilated and unreactive to light. Visual and auditory
hallucinations and tachycardia have also been reported.
Question 6 of 66
A 70-year-old woman presented with episodic impairment of consciousness.
Which of the following is the most likely cause?
Available marks are shown in brackets
1 ) Alzheimer type dementia [0]
2 ) chronic sub-dural haematoma [100]
3 ) Creutzfeldt-Jacob disease [0]
4 ) depressive stupor [0]
5 ) normal pressure hydrocephalus [0]
Comments:
This is quite a grey question. The clinical scenario is very brief with no mention of
any neurological signs so a logical deduction must be made.
Alzheimer's disease would be expected to have a continous impairment of
consciousness in its advanced stages but could be episodic if there were variation in
drugs therapy or concurrent illnesses. Similarly Normal Pressure Hydrocephalus,
Creutzfeld-Jacob and depression would present with dementia (or apparent dementia)
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~)!@!@@
ych_exam.doc@@@@@@@@@@@@!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
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,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~)!@!@@
ych_exam.doc@@@@@@@@@@@@!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
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but not fluctuant.
Of all those listed subdural haematoma is classically associated with fluctuating level
of consciousness. This would make it the most likely.
Question 7 of 66
Which of the following features is characteristic of early Alzheimer's disease?
Available marks are shown in brackets
1 ) ataxic gait [0]
2 ) impaired short term memory [100]
3 ) myoclonic jerks [0]
4 ) urinary incontinence [0]
5 ) visual hallucinations [0]
Comments:
Alzheimer's disease is characterised early in the disease by short term memory loss.
The other features listed here would suggest an alternative diagnosis such as normal
pressure hydrocephalus (gait ataxia and urinary incontinence), Creutzfeld-Jacob
disease (myoclonic jerks) and delirium or vascular dementia (visual hallucinations).
Question 8 of 66
A 70-year-old woman had a major depressive disorder which was unresponsive to
antidepressant medication.
Which one of the following statements is correct?
Available marks are shown in brackets
1 ) Associated dementia is unlikely [0]
2 ) Electroconvulsive therapy is likely to improve her mood [1
3 ) If she recovers, relapse is unlikely [0]
4 ) The risk of suicide is low [0]
5 ) Underlying physical illness is unlikely [0]
Comments:
Depression in the elderly is a widespread problem that is often not diagnosed and
frequently undertreated. Depression can also be a sign of a medical problem. It may
be complicated by brain disorders associated with the aging process such as
Alzheimers disease. Suicide risk in the elderly is an important consideration, and is at
least ascommon as in younger age groups. Relapse of depressive symptoms is
common in the elderly. ECT is indicated in patients who derive no benefit from
antidepressant medication.
Question 9 of 66
A 52-year-old male is admitted after taking an overdose.
Which single feature best suggests a high risk of future suicide?
Available marks are shown in brackets
1 ) Making plans before the overdose to avoid discovery [100]
2 ) Ingestion of alcohol with the overdose drug [0]
3 ) Ingestion of more than one drug [0]
4 ) Ingestion of more than 100 tablets [0]
5 ) Previous history of overdose [0]
Comments:
The effort to conceal the overdose suggests a serious intent to commit suicide more so
than the other options given. Previous history of overdoses (rather than parasuicide –
as we don't know exactly whats being taken - they could take an overdose of Cod
Liver Oil!) does not necessarily imply a more serious intent. Other factors that would
imply a more sinister intent would be male, elderly with mental illness.
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~)!@!@@
ych_exam.doc@@@@@@@@@@@@!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
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ych_exam.doc@@@@@@@@@@@@!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
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Examination Practice: Psychiatry
Question 1 of 66
A 17-year-old female is referred with a six month history of amenorrhoea and
weight loss, for which no organic cause can be found. Which of the following
features would support a diagnosis of anorexia nervosa?
Available marks are shown in brackets
1 ) Delusions of poisoning [0]
2 ) Hypotrichosis [0]
3 ) Hypergonadotrophic hypogonadism [0]
4 ) Delsuion of being overweight [100]
5 ) Watery diarrhoea [0]
Comments:
Features of AN include a phobic avoidance of normal weight, relentless dieting,
selfinduced vomiting, laxative use, excessive exercise, amenorrhoea, lanugo hair,
hypotension, denial, concealment, overperception of body image, enmeshed families.
Question 2 of 66
A 17-year-old student presented with recurrent attacks of dizziness.
Which one of the following additional features is most suggestive that she has an
anxiety disorder?
Available marks are shown in brackets
1 ) elevated diastolic blood pressure [0]
2 ) nocturia [0]
3 ) paraesthesiae in the hands [100]
4 ) rotational vertigo [0]
5 ) tinnitus [0]
Comments:
Paraesthesia is often experienced with hyperventilation associated with anxiety
disorders and is often in hands, feet and peri-orally. Rotational vertigo and tinnitus
suggest an organic disorder, whilst anxiety disorder may be associated with raised
systolic blood pressure
Question 3 of 66
A 22-year-old woman presented following an overdose. She had had an argument
with her boyfriend and had then driven to an isolated country lane where she had
swallowed 20 Paracetamol tablets and a bottle of wine.
Which one of the following is the strongest predictor that she may later make a fatal
suicide attempt?
Available marks are shown in brackets
1 ) Female gender [0]
2 ) Location of the suicide attempt [100]
3 ) Taking alcohol with the tablets [0]
4 ) The argument with the boyfriend [0]
5 ) The number of tablets [0]
Comments:
About one-third of people who attempt suicide will repeat the attempt within one
year, and about 10% of those who threaten or attempt suicide eventually do kill
themselves.
There are certain characteristics that have been found in those who are more likely to
repeat an attempted suicide.
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~)!@!@@
ych_exam.doc@@@@@@@@@@@@!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
20220323184212_623b6a04d50d8_psych_exam.doc@@@@@@@@@@@@!!!!!!!!!!!!!!!!!!!!!!!20220323184212_623b6a04d50
,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~)!@!@@
ych_exam.doc@@@@@@@@@@@@!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
20220323184212_623b6a04d50d8_psych_exam.doc@@@@@@@@@@@@!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((
These characteristics include: age of 45 or more; the fact of being male; a previous
attempt which resulted in hospital admission; problems with drugs or alcohol;
suffering from a personality disorder; living alone (especially if separated, divorced,
or widowed); previous history of psychiatric treatment, criminal record,
unemployment and lower social class. Relational pathology, for example an ongoing
difficulty with her relationship with her boyfriend, is also a recognised factor for
repeat suicide attempts. The fact that we do not know whether she has ongoing
relationship problems means that we can not class this as the strongest predictor of
future suicidal intent.
Thus, the fact that she drove to an isolated area, where there was little chance of her
being found, suggests that this is a serious attempt at suicide, which predicts future
suicidal intent
Question 5 of 66
A 63-year-old man was found collapsed. A Department of Psychiatry outpatient
Card was found in his jacket, together with a bottle of procyclidine tablets. He was
febrile (38.2°C), conscious but unresponsive to commands. The blood pressure was
160/105 mmHg and there was marked muscle rigidity.
What is the most likely diagnosis?
Available marks are shown in brackets
1 ) acute catatonic schizophrenia [0]
2 ) bacterial meningitis [0]
3 ) cerebral malaria [0]
4 ) neuroleptic malignant syndrome [100]
5 ) procyclidine overdose [0]
Comments:
The symptoms are typical of neuroleptic malignant syndrome (NMS). NMS is
characterized by fever, muscular rigidity, altered mental status, and autonomic
dysfunction. Procyclidine is used to treat the Parkinsonian side-effects of
neuroleptics:
its presence in the patient's pocket implies that he was taking neuroleptics. Signs of
procyclidine overdose include agitation, confusion, and sleeplessness lasting up to 24
hours or more. Pupils are dilated and unreactive to light. Visual and auditory
hallucinations and tachycardia have also been reported.
Question 6 of 66
A 70-year-old woman presented with episodic impairment of consciousness.
Which of the following is the most likely cause?
Available marks are shown in brackets
1 ) Alzheimer type dementia [0]
2 ) chronic sub-dural haematoma [100]
3 ) Creutzfeldt-Jacob disease [0]
4 ) depressive stupor [0]
5 ) normal pressure hydrocephalus [0]
Comments:
This is quite a grey question. The clinical scenario is very brief with no mention of
any neurological signs so a logical deduction must be made.
Alzheimer's disease would be expected to have a continous impairment of
consciousness in its advanced stages but could be episodic if there were variation in
drugs therapy or concurrent illnesses. Similarly Normal Pressure Hydrocephalus,
Creutzfeld-Jacob and depression would present with dementia (or apparent dementia)
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~)!@!@@
ych_exam.doc@@@@@@@@@@@@!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
20220323184212_623b6a04d50d8_psych_exam.doc@@@@@@@@@@@@!!!!!!!!!!!!!!!!!!!!!!!20220323184212_623b6a04d50
,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~)!@!@@
ych_exam.doc@@@@@@@@@@@@!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
20220323184212_623b6a04d50d8_psych_exam.doc@@@@@@@@@@@@!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((
but not fluctuant.
Of all those listed subdural haematoma is classically associated with fluctuating level
of consciousness. This would make it the most likely.
Question 7 of 66
Which of the following features is characteristic of early Alzheimer's disease?
Available marks are shown in brackets
1 ) ataxic gait [0]
2 ) impaired short term memory [100]
3 ) myoclonic jerks [0]
4 ) urinary incontinence [0]
5 ) visual hallucinations [0]
Comments:
Alzheimer's disease is characterised early in the disease by short term memory loss.
The other features listed here would suggest an alternative diagnosis such as normal
pressure hydrocephalus (gait ataxia and urinary incontinence), Creutzfeld-Jacob
disease (myoclonic jerks) and delirium or vascular dementia (visual hallucinations).
Question 8 of 66
A 70-year-old woman had a major depressive disorder which was unresponsive to
antidepressant medication.
Which one of the following statements is correct?
Available marks are shown in brackets
1 ) Associated dementia is unlikely [0]
2 ) Electroconvulsive therapy is likely to improve her mood [1
3 ) If she recovers, relapse is unlikely [0]
4 ) The risk of suicide is low [0]
5 ) Underlying physical illness is unlikely [0]
Comments:
Depression in the elderly is a widespread problem that is often not diagnosed and
frequently undertreated. Depression can also be a sign of a medical problem. It may
be complicated by brain disorders associated with the aging process such as
Alzheimers disease. Suicide risk in the elderly is an important consideration, and is at
least ascommon as in younger age groups. Relapse of depressive symptoms is
common in the elderly. ECT is indicated in patients who derive no benefit from
antidepressant medication.
Question 9 of 66
A 52-year-old male is admitted after taking an overdose.
Which single feature best suggests a high risk of future suicide?
Available marks are shown in brackets
1 ) Making plans before the overdose to avoid discovery [100]
2 ) Ingestion of alcohol with the overdose drug [0]
3 ) Ingestion of more than one drug [0]
4 ) Ingestion of more than 100 tablets [0]
5 ) Previous history of overdose [0]
Comments:
The effort to conceal the overdose suggests a serious intent to commit suicide more so
than the other options given. Previous history of overdoses (rather than parasuicide –
as we don't know exactly whats being taken - they could take an overdose of Cod
Liver Oil!) does not necessarily imply a more serious intent. Other factors that would
imply a more sinister intent would be male, elderly with mental illness.
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!~~~~~~~~~~~~~~~~)!@!@@
ych_exam.doc@@@@@@@@@@@@!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!))))))))))))(((((((((((((((((((((())))))))))))))))))))))))))!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
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