Persistent lying in an alcoholic (718/1700)

A 62yo male is brought to the ED by his daughter because of his persistent lying. He is a known
alcoholic and has been admitted recently with delirium tremens. On questioning, he denies any
problem with memory. He knows his name and address and states that was at the betting shop
this morning, but his daughter interjects calling him a liar explaining that he was at her home.
What is the most likely dx?

a. Ganser syndrome
b. Cotard syndrome
c. Wernicke’s encephalopathy
d. Korsakoff psychosis
e. Alcohol withdrawal

Peri-oral tinging and carpo-pedal spasm (658/1700)

A 24yo woman presents with episodes of peri-oral tingling and carpo pedal spasms every time
she has to give a public talk. This also happens to her before interviews, exams and after arguments. What is the best management strategy for this pt?

a. Diazepam
b. Rebreathe in a paper bag
c. Desensitization
d. Buspirone
e. Propranolol

Hallucinations (605/1700)

A 32yo lady complains that she hears everyone saying that she is an evil person. What type of hallucinations is she suffering from?

a. 2nd person auditory hallucinations
b. 3rd person auditory hallucinations
c. Echo de la pense
d. Gedankenlautwerden

Alcohol addiction (1225/1700)

A 56yo alcoholic man who has increased the amount of alcohol he is using wants to attend his daughter’s wedding that is in 2wks. He is now coming to you for help. How would you help him?

a. Acamprosate
b. Refer to clinical psychologist
c. Refer to GP
d. Despiramine
e. Refer to community mental health support group

Feels like she has cancer (1083/1700)

A 24yo lady has been low after the death of her husband and had stopped contacting her family. She was started on SSRI tx and starts feeling better after a few months. On discontinuating the meds she starts feeling that she has developed cancer just like her husband.
What is the most appropriate next step?

a. Continue SSRI
b. Add TCA
c. Neuropsychiatric analysis
d. CBT
e. Antipsychotics

His movements are being watched (1439/1700)

A 20yo man complains that all his movements are being watched. Sometimes he feels as though his actions are being controlled by his radio. At other times he is aware of voices describing what he is doing. What is the most probable dx?
a. Mania
b. Drug induced psychosis
c. Delusion of control
d. Schizophrenia
e. Korsakoff psychosis

Homeless man (1328/1700)

A homeless person is found wandering on the street. He had ataxic gait, nystagmus and opthalmoplegia. He looked unkempt and his clothes had a sweaty odour. He had a dry mucous membrane with a BP=118/70mmHg and PR=90bpm. Blood sugar level=8. Alcohol breath test= -ve. What would the most imp initial inv?

a. IV insulin
b. Vit B complex
c. Bolus IV 0.9%NS
d. IV dextrose
e. Antibiotics

Bilateral parotid swelling and calluses on hand (560/1700)

A thin 18yo girl has bilateral parotid swelling with thickened calluses on the dorsum of her hand.
What is the single most likely dx?
a. Bulimia nervosa
b. C1 esterase deficiency
c. Crohn’s disease
d. Mumps
e. Sarcoidosis

Palpitations, sweating, fear (549/1700)

A 21yo woman has had several sudden onset episodes of palpitations, sweating, nausea and
overwhelming fear. On one occasion she was woken from sleep and feared she was going insane.
There is no prv psychiatric disorder. What is the most probable dx?
a. Pheochromocytoma
b. Panic disorder
c. GAD
d. Phobia
e. Acute stress disorder

Overdose pt refusing treatment (526/1700)

A 34yo man with MS has taken an OD of 100 tablets of paracetamol with intent to end his life.
He has been brought to the ED for tx but is refusing all intervention.
a. Assessment
b. Evaluate pt’s capacity to refuse tx
c. Establish if pt has a prv mental illness

Anxiety disorder (742/1700)

A 23yo man feels anxious and agitated when faced with stress. He has an interview in 3days and
would like some help in relieving his symptoms. What is the most appropriate management?

a. SSRI
b. CBT
c. Propranolol
d. Diazepam

Lithium and Pregnancy (511/1700)

A 26yo woman had bipolar disorder for 10yrs and is on Lithium for it. She is symptom free for
the past 4 years. She is now planning her pregnancy and wants to know whether she should
continue taking lithium. What is the single most appropriate advice?
a. Continue lithium at the same dose and stop when pregnancy is confirmed
b. Continue lithium during pregnancy and stop when breast feeding
c. Reduce lithium dosage but continue throughout pregnancy
d. Reduce lithium gradually and stop when pregnancy is confirmed
e. Switch to sodium valproate

Type of depression (492/1700)

A 40yo woman presents to the GP with low mood. Of note, she has an increased appetite and
has gone up 2 dress sizes. She also complains that she can’t get out of bed until the afternoon.
What is the most likely dx?
a. Pseudo depression
b. Moderate depression
c. Severe depression
d. Dysthymia
e. Atypical depression

Feels down, Previously Overspending and Promiscuous (488/1700)

A 24yo man asks his GP for a sick note from work. He says that feels down, is lethargic and has
stopped enjoying playing the piccolo (his main hobby). He was admitted to the psychiatry ward
last year following an episode of overspending, promiscuity and distractibility. What is the most
probable dx?
a. Psychosis
b. Cyclothymia
c. Bipolar affective disorder
d. Seasonal affective disorder

Psyciatric terms (480/1700)

A 23yo man comes to the ED with a hx of drug misuse. He recognizes that he has a prb and is
willing to see a psychiatrist. Which of the following terms best describes this situation?
a. Judgement
b. Thought insertion
c. Thought block
d. Mood
e. Insight

Disheveled unkempt old lady (472/1700)

A 71yo woman looks disheveled, unkempt and sad with poor eye contact. She has recently lost
her husband. Which of the following describes her condition?
a. Anxiety
b. Hallucination
c. Mania
d. High mood
e. Low mood

Post operative aggression (468/1700)

A 62yo man who was admitted for surgery 3days ago suddenly becomes confused. His attn span
is reduced. He is restless and physically aggressive and picks at his bed sheets. What single
aspect of the pt’s hx recovered in his notes is most likely to aid in making the dx?
a. Alcohol consumption
b. Head trauma
c. Hx of anxiety
d. Prescribed med
e. Obvious cognitive impairment

Intermittent tension, dizziness and anxiety (470/1700)

A 40yo woman has had intermittent tension, dizziness and anxiety for 4months. Each episode
usually resolves after a few hours. She said she takes alcohol to make her calm. She is in a loving
relationship and has no probs at work or home. What is the next step in her management?
a. Collateral info
b. CT brain
c. CBC
d. LFT
e. TFT

Woman says she died 3months ago (451/1700)

A 65yo woman says she died 3m ago and is very distressed that nobody has buried her. When
she is outdoors, she hears people say that she is evil and needs to be punished. What is the
most likely explanation for her symptoms?
a. Schizophrenia
b. Mania
c. Psychotic depression
d. Hysteria
e. Toxic confusional state

Treatment of OCD (450/1700)

A 32yo man has OCD. What is the best tx?
a. CBT
b. SSRI
c. TCA
d. MAO inhibitors
e. Reassure