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Psychiatry 1 MCQ’s

With personality disorders, the following are true EXCEPT Cluster ‘C’ represents the ‘anxious & fearful’ group of personality disorders Personality disorder is a ‘Axis III’ diagnosis Both Anti-social and Histrionic personality disorders are found in Cluster ‘B’ A person with Avoidant personality disorder is socially withdrawn but actually would like to have friends Organic causes for mental disorder are more likely in all the following EXCEPT those with The following is FALSE with regards to the Mini-Mental State Examination: Has a sensitivity of 87% for presence of delirium Has a specificity of 82% for presence of delirium A score less than 20 suggests organic brain aetiology Is used to differentiate delirium from dementia With regards to drugs used for chemical restraint , which is FALSE? Droperidol has no anti-psychotic properties Extrapyramidal side-effects are commoner with droperidol than haloperidol. Which of the following is NOT an axis 1 diagnosis
Which of the following is an easily reversible cause of dementia? Which statement is FALSE regarding the following Anti-depressants Tricyclics inhibit the pump mechanism responsible for the reuptake of Serotonin and Noradrenaline into neurons. Mirtazapine causes release of Serotonin and Noradrenaline and at the same time and the same time acts as a potent 5-HT2 and 5-HT3 antagonist Venlafaxine causes release of Serotonin and Noradrenaline Moclobemide is a reversible monoamine oxidase inhibitor Schizophreniform disorder is a brief psychotic episode that lasts < 1 month The gender ratio of death by suicide in Australasia is 10 males to 1 female A patient that requires a police escort for a psychiatric presentation is Australasian Triage Scale Category 2 Personality disorders are considered in Axis I of the DSM-IV classification system Which is associated with a relatively lower suicide completion risk? A young man, smelling of alcohol, is brought into your ED by Police who are concerned. He is aggressive and demanding to be discharged. How do you best proceed next? Admit under Form I of the Mental Health Act Admit under Form III of the Mental Health Act Which of the following suggest a low risk for suicide at the time of interview? Refusal to provide additional information Nonauditory hallucinations suggest an organic cause A psychotic disorder precipitated by an extremely traumatic life experience, lasting less than 4 weeks is characteristic of a Schizophreniform disorder Dissociative Disorders include episodes of amnesia that are rarely permanent Motor seizures secondary to alcohol withdrawal typically occur 24-48 hours after cessation of intake A 20yo female patient arrives having cut her arms and taken an unknown quantity of an antidepressant she cannot remember the name of. Which of the following is NOT a correct issue of concern in her management? A history of multiple previous minor DSH makes her high risk for suicide. Co-ingestion of alcohol increases her likelihood of suicide. A subsequent convulsion does not clarify the mot likely antidepressant taken. A co-ingestion of benzodiazepine is likely to worsen her outcome. A 12 year-old girl is brought in by her mother as she has recurrent severe abdominal pain which the GP has not been able to identify despite repeated reviews, bloods and an USS. She is trendily dressed with plenty of make-up. It is important that you…. Concentrate on her abdominal symptoms and signs as the GP is clearly incapable of basic medical management. Include an assessment of her fingertips, teeth, gag reflex and hair. Talk to the patient with her mother present to ensure she gives you an accurate history. Concentrate on her previous history of DSH, depression and alcohol ingestion. Which of the following is TRUE regarding Bipolar affective disorder? Rapid Cyclers have 5 or more episodes of mania and depression per year. Criteria include poor self esteem and flight of ideas Most patients with a manic state do not have Bipolar affective disorder The leading cause of death in Australia in the under 30’s is Patients with schizophrenia typically complain of: Which feature is MOST consistent with an acute psychotic illness? In regard to Phobias & Panic disorders, which statement is FALSE? Patients suffering social or specific phobias may experience situational bound or situational predisposed panic attacks. Patients suffering from panic disorder or depression may have panic attacks without any trigger needed. With ‘phobia’, the patient is unable to recognise that the fear is excessive. Symptoms typical of ‘panic attack’ may occur in association with numerous medical conditions. All of the following have been associated with neuroleptic malignant syndrome EXCEPT : With regard to extrapyramidal movement disorders They may be reversible on ceasing antipsychotics They are experienced in up to 90% of patients taking typical anti-psychotics Dystonic reactions more commonly affects muscles of the back and arms Parkinsonism occurs late (after years) in the treatment with anti-psychotics Which statement regarding Lorazepam is FALSE? Lorazepam may be given undiluted by Intra-Muscular injection for Status Epilepticus Lorazepam requires dilution with equal volume of a compatible fluid e.g. 5% Dextrose before using Intra-Venously Flumazenil is the anti-dote to use in the patient with suspected Lorazepam overdose Lorazepam may be used for short term treatment of Anxiety and Insomnia Which statement regarding Doxepin overdose is FALSE? Its anti-histamine effects are more marked than most other TCA drugs. TCA’s do not antagonise Acetyl-choline at the Nicotinic receptors Doxepin causes seizures through its antagonism of GABA receptors and Sodium channel blockade Neurotoxicity with subsequent seizure is the most important factor causing mortality A 48yo woman has ingested an unknown amount of Lithium carbonate 2 hours ago. This had been started 3 weeks ago by her psychiatrist. Which of the following is TRUE? A lithium level should be taken at 4 hours post ingestion The first signs of toxicity are usually gastrointestinal symptoms The most common ECG abnormality is QRS prolongation Ataxia is a late sign of significant toxicity A patient who is on an MAO-I antidepressant, Moclobemide, presents with a fever, hypertension and rigidity. Which of the following would be the least likely to be a precipitant of this presentation? Well ripened cheese ingestion 3 days earlier Cold and flu tablets containing Pseudoephedrine Which of the following is TRUE regarding atypical antipsychotics? Olanzapine has a good safety profile in diabetics Risperidone is particularly safe in the elderly demented patient Risperidone is more rapidly bioavailable than Olanzapine orally Olanzapine and Risperidone exert their actions by acting on 5HT1 and D1 receptors Olanzapine acts at which of the following receptors? Atypical antipsychotics are associated with increased mortality in? Which would NOT be expected in 3g Venlafaxine overdose in adult? Which of the following is NOT a side effect of Sertraline use? Risk factors for increased toxicity of lithium include all the following EXCEPT…. Which of the following is found in anorexia nervosa? Lower mortality in bulimics compared with pure anorexics. Which of the following is FALSE with regards to Schizophrenia? It is characterized by loosening of associations, auditory hallucinations and delusions Relapse is commonly associated with non-compliance with medications Hallucinations are required to make a diagnosis Which of the following statements is FALSE? In Panic Disorders, anxiety and fear are more common presentations to ED than palpitations, sweating, SOB and dizziness An example of a Phobic Disorder is Anataediphobia In General Anxiety Disorders, fear exceeds that of the expected threat Obsessive Compulsive Disorder is characterized by unpleasant intrusive thoughts Which of the following is NOT a feature of Delirium? Determination of a pathogenic cause is required Regarding conversion disorders which is FALSE They are defined as a loss or change of function suggesting a physical disorder but caused by a psychological conflict 90% of the time present as neurological symptoms/disorders Often the patient seems relatively unconcerned about the symptom The symptom production is a conscious one Which of the following is INCORRECT regarding panic attacks Hyperventilation can cause T wave changes on ECG SpO2 will be normal to make this diagnosis There is no associated suicide risk with recurrent episodes Medications that are known to be significantly associated with depression include all of the following EXCEPT: Medical conditions that are associated with depression include all of the following EXCEPT: Which of the following is uncommon in delirium Citalopram – serotonin and noradrenaline reuptake inhibitor Mirtazapine – noradrenaline and selective serotonin antagonist Sertraline – selective serotonin reuptake inhibitor Moclobemide – reversible monoamine oxidase inhibitor Is typically associated with olfactory hallucinations Has a prevalence of 1-2% of the population Which of the following is a NOT a high risk factor for suicide in Australia? Which of these patients would MOST appropriately be assigned an ATS2 triage category? A cooperative patient requesting treatment for depression. A tearful and anxious patient who keeps returning to the triage desk to ask how long the wait to be seen is. An agitated patient who says he can see demons in the walls. Suicide is the second leading cause of death in Australia for those aged <30 years after trauma. A psychiatric diagnosis is present in 90% of completed suicides. Men are more likely to have successful suicide attempts and have a higher lifetime prevalence of suicide attempts than women. Patients rarely seek help prior to suicide. Which of the following is TRUE regarding suicide? Both hanging, and deliberate self poisoning are the most frequent methods of female suicide Males aged 30-34 have the highest age specific rates of suicide Schizophrenia carries greater suicide risk than other psychiatric disorders. 20% of people who commit suicide present to an ED in the month prior to death
Answers

1. B
2. D
3. D
4. D
5. D
6. A
7. C
8. C
9. D
10. B
11. C
12. B
13. D
14. B
15. B
16. C
17. D
18. B
19. C
20. A
21. B
22. C
23. D
24. B
25. C
26. C
27. D
28. D
29. A
30. C
31. C (theo increases clearance of lithium. causes cardiac abnormalities = Ebsteins
32. D
33. D No hallucinations in ‘Catatonic’ (waxy flexibility, mute, rigidity and hypertonic) and
34. A 35. D 36. C 37. D Dunn 38. D Dunn 39. A Textbook of Adult Emergency Medicine (Cameron et al.), 3rd ed., p.637 40. A Textbook of Adult Emergency Medicine (Cameron et al.), 3rd ed., p.637 41. B Cameron, page 623 42. A Trevor’s notes 43. A B – auditory hallucinations, C – male:female 1:1, D – prevalence 0.2-0.5% 44. C males higher risk for successful suicide (except China) Cameron Chapter 45. D Dunn p833 (A: ATS1, B: ATS4or5, C: ATS3or4, D: ATS 2 due to hallucinations) 46. B Dunn p843 (leading cause, men are more successful but women are more likely to attempt, pts commonly seek help prior to suicide) 47. A Cameron (3rd ed) p 625-627. A: Hanging and DSP 40% each of female suicides (total 80%), 50 and 30% respectively for males (80%) B: Males >80yrs greatest age specific risk. Though also peak 30-34 years C: Mood disorders (esp major depression) greatest suicide risk D: 10% suicides seen in ED

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