Quiz 1

 

Take the quiz below to test your knowledge

 

  1. Select the most appropriate choice from the above where you would record the information obtained.

‘I don’t know what to do, doctor. I know that they are monitoring my actions using special radio waves and there’s no way I can get away from it.’ 

  • A. Thought form 

  • B. Speech 

  • C. Mood 

  • D. Thought content 

  • E. Abnormal perception 

 

2. Select the most appropriate choice for where you would record the information obtained here:

‘I’m not eating anymore, and I constantly feel guilty for every- thing. I feel like I’m in a deep trench and I’m suffering down below.’ 

  • A. Behaviour 

  • B. Thought form

  • C. Thought content 

  • D. Affect 

  • E. Mood

 

3. Select the most appropriate choice for where you would record the information obtained here:

‘After that, I decided to go home ... Home and away ... Swaying my way.’ 

  • A. Speech

  • B. Behaviour 

  • C. Thought form

  • D. Thought content 

  • E. Abnormal perception 

4. Select the most appropriate item that best describes the clinical presentation depicted here:

‘Yes I do take my medications as directed, doctor. I take one tablet every morning after having my breakfast, and then it was his turn to be punished. It’s a fight involving everyone, but the unaffected third party just pretended nothing happened.’ 

  • A. Diminished insight 

  • B. Knight’s move thinking

  • C. Circumstantiality

  • D. Flight of ideas

  • E. Tangentiality

 

5. Select the most appropriate diagnosis that best fits with the given clinical description.

A 28-year-old female presents to the clinic complaining of low mood. She describes her mood as ‘depressing’ and is unable to do anything. Because of her low mood, she has not eaten for 3 days. She mentions that a year ago, she was feeling on top of the world and went through periods when she did not sleep. On that occasion, she was admitted to hospital when her parents thought that she was going ‘out of control’. 

  • A. Bipolar affective disorder 

  • B. Mild to moderate depressive episode

  • C. Dysthymia 

  • D. Cyclothymia 

  • E. Mania 

 

 

6. Select the most appropriate diagnosis that best fits with the given clinical description.

A 28-year-old female presents to the clinic complaining of low mood. She has been feeling like this for the last 3 months and is unable to identify any triggers. She feels tearful and does not seem to enjoy things she once did. She is still able to go to work, although at times it has been difficult for her to concentrate. Her appetite has decreased but she manages to sleep around 7 hours per night. 

  • A. Bipolar affective disorder 

  • B. Depressive episode, mild 

  • C. Depressive episode, moderate 

  • D. Depressive episode, severe 

  • E. Dysthymia 

 

7. . Select the most appropriate personality disorder that fits with the following clinical description:

A 19-year-old male dropped out of school at the age of 13 years for violent behaviour. He has been spending his days doing nothing but pacing around the streets and pick-pocketing from strangers. He has been convicted several times in the past for armed robbery, and claims that this was done for self-defence. He appears to have no remorse for the victims, and has never been able to maintain a relationship. 

  • A. Antisocial

  • B. Psychopathic

  • C. Borderline

  • D. Paranoid 

  • E. Schizoid

 

8. Select the most appropriate personality disorder that fits with the following clinical description:

A 20-year-old female with a history of childhood sexual abuse has chronic suicidal ideation. She is currently in an unstable relationship marked by frequent arguments, but still prefers to be with her boyfriend. She presents to the hospital today for deliberate self-harm, and tells the duty doctor: ‘You are the best doctor I have ever come across’. 

  • A. Borderline

  • B. Dependent

  • C. Histrionic

  • D. Narcissistic

  • E. Obsessive compulsive 

 

 

9. Select the most likely diagnosis:

A 60-year-old male is brought to hospital with fluctuating consciousness and injury to his forehead. He has a history of alcohol abuse. His cognition reveals marked short-term memory loss, confabulation, and labile personality. On review by the psychiatrists, they feel that this condition is hard to reverse. 

  • A. Acute alcohol withdrawal 

  • B. Alcoholic intoxication

  • C. Delirium tremens 

  • D. Korsakoff’s syndrome

  • E. Wernicke’s encephalopathy 

 

10. Select the most appropriate option that is most likely to be seen in the following scenario.

A 30-year-old male with several psychiatric admissions in the past presents to hospital complaining that the government is sending signals to his brain to control his thoughts and behaviours. 

  • A. Flattening of neuronal discharges on EEG 

  • B. Presence of eosinophilic intracytoplasmic neuronal inclusions with a normal phosphorylation 

  • C. Raised dopamine sensitivity in neuronal pathways 

  • D. Reduced level of serotonin and noradrenaline function in neuronal pathways 

  • E. Reduced dopamine sensitivity in neuronal pathways 

 

11. Select the most likely diagnosis

A 65-year-old female is brought to hospital by the police after she is found wandering the streets in the middle of the night. She cannot recall her address and is disorientated to time and place but not to person. Her consciousness appears intact. Physical examination and blood tests are normal. Her past medical history is unremarkable. 

  • A. Alzheimer’s disease 

  • B. Korsakoff’s syndrome

  • C. Delirium

  • D. Mild cognitive disorder 

  • E. Vascular dementia

 

12. Select the most likely treatment for the following statement.

 A 48-year-old man with a long history of heavy alcohol use has attended a 2-week residential alcohol detoxification programme. At the time of discharge, he was dispensed with this medication to control his craving.

  • A. Acamprosate

  • B. Lofexidine

  • C. Naltrexone

  • D. Disulfiram

  • E. chlordiazepoxide

 

13. Select the most likely diagnosis for the following statement.

A 22-year-old male is commenced on an antipsychotic medication. Few days later on the ward, he complains of feeling anxious and restless. He is unable to keep his legs from moving and has been pacing up and down the corridors. He is distressed by his symptoms and has been expressing suicidal thoughts. His urine drug screen was negative. 

  • A. Akathisia

  • B. Alcohol withdrawal

  • C. Acute stress reaction 

  • D. Parkinsonism

  • E. General anxiety disorder with depressive features

 

 

14. Select the most likely diagnosis for the following statement.

An 18-year-old male college student presents to the hospital Emergency Department following a panic attack. He is agitated and is suspicious of nursing staff, claiming that ‘they’ are against him. On examination, he is tachycardic and has red eyes. There have been no recent stressful events in his life and he has no past psychiatric history. 

  • A. Acute stress reaction 

  • B. Benzodiazepine withdrawal 

  • C. Cannabis intoxication 

  • D. Cocaine intoxication 

  • E. First psychotic episode

 

15.  Select the most likely diagnosis: for the following statement.

A 52-year-old female is admitted to a medical ward with an acute exacerbation of Crohn’s disease, requiring high-dose steroids. After a few days, however, she accuses the nurses on the ward of stealing her money and believes that one of the male nurses assaulted her during the night. However, once her steroids are stopped, she starts to settle.

  • A. Transient psychotic disorder 

  • B. Bipolar affective disorder 

  • C. Delirium 

  • D. Schizoaffective disorder

  • E. Organic delusional disorder 

 

16. Select the most likely diagnosis that best fits with the following clinical description.

A 22-year-old male is preoccupied with the fear that he has cancer. He has had a number of investigations which have not revealed any abnormalities, but is not reassured. He has visited three hospitals in the last year. 

  • A. Generalised anxiety disorder 

  • B. Hypochondriasis 

  • C. Malingering

  • D. Panic disorder 

  • E. Somatisation 

 

17. Select the most likely diagnosis for the following statement.

A 68-year-old male is admitted under the medical team for dehydration after refusing to eat or drink. His wife reports that he has been preoccupied with the belief that he has a brain tumour. He has lost 12kg in weight and spends most of his day in bed. He reports that he can smell rotting bodies and believes that he has committed a sinful crime because he has heard voices calling him a paedophile. He feels ashamed of himself. 

  • A. Alzheimer’s disease 

  • B. Delirium 

  • C. Depression with psychotic features 

  • D. Paranoid schizophrenia 

  • E. Schizoaffective disorder 

ANSWERS:

 

1. D. The correct answer is thought content. Any notable content of thought should be recorded here, including the presence of delusions, obsessive thoughts, and phobias. You should also assess for any ideations of harming self or others. 

2. E. The correct answer is: Mood. Features of subjective (patient’s own words) and objective (as observed in interview) mood should be recorded under ‘mood’, including any associated biological features such as the effect of mood on appetite and sleep. 

3. C. The correct answer is thought form. This is an example of flight of ideas. This is a rapid succession of thoughts vaguely associated with the sounds of other words. There may be punning and rhyming. This commonly occurs in patients with mania (Bipolar Affective Disorder). It can be associated with pressure of speech. 

4. B.The correct answer is Knight’s move thinking. Knight’s move thinking is a type of formal thought disorder in which the patient starts answering the question appropriately, but the line of thought is suddenly shifted to an unrelated topic. It is also known as derailment of thought. The answer is not tangentiality- this is a related formal thought disorder in which the patient starts answering the question, but then talks off the topic in an area that is only indirectly related to the intended answer (‘talking off the point’). As a result, the answer to the original question is not reached. 

5. A. The correct answer is Bipolar Affective Disorder. It sounds like a mild or moderate depressive episode, but given the patient’s previous history of a manic episode, the best diagnosis is bipolar affective disorder. Bipolar is by definition characterised by two or more episodes of significant mood disturbance, of which one episode must be hypomania or mania. 

6. B. The correct answer is Depressive Episode, mild. Depressive disorders are classified into mild, moderate, severe without psychotic features, and severe with psychotic features according to ICD-10. The severity of the episode is dependent on the number and intensity of the depressive symptoms, and must be present for at least 2 weeks

  1. depressive symptoms are low mood, decreased energy, anhedonia. 

  2. symptoms are disturbed sleep, diminished appetite, self-harm impulses, disturbed attention/concentration, feelings of guilt/worthlessness, hopelessness, low self-esteem. 

The following are the diagnostic guidelines for ICD-10: 

  • : Total of four core and associated (at least two core symptoms). 

  • : Six core and associated symptoms (at least two core symptoms). 

  • : Eight core and associated symptoms (all core symptoms needed).

 

7. A. The correct answer is Antisocial. Antisocial personality disorder is characterised by irresponsibility and disregard for social norms and rules, callous disregard for the feelings of others, tendency to become aggressive, inability to experience guilt, inability to learn from punishment, tendency to blame others, and an inability to maintain relationships. There are some similarities with people who would be described as psychopathic on the Hare’s Psychopathy Checklist. However, ‘psychopathic’ is not a type of personality disorder and you would need more information to assess this.

 

8. A. The correct answer is Emotionally Unstable (borderline). Borderline personality disorder is characterised by disturbances in self-image and/or internal preferences (such as sexuality), intense and unstable relationships, self-harming, excessive efforts to avoid abandonment, and chronic feelings of emptiness. People with Borderline Personality may unconsciously try to split professionals, depending on how the relate to the individual. A fairly significant proportion of people who deliberately self-harm and present to hospital fall into this category. 

 

9. D. The correct answer is Korsakoff’s syndrome. Korsakoff’s syndrome is characterised by an inability to form new memories. There is relative preservation of other intellectual functioning (such as working memory) and patients may confabulate (fabrication of recollection of experiences in clear consciousness in order to fill in gaps in memory). This is usually irreversible.

 

10. C. The correct answer is ‘Raised dopamine sensitivity in neuronal pathways’. The diagnosis here is schizophrenia, and the dopamine hypothesis remains the most accepted theory for the aetiology of psychotic disorders. Evidence for dopamine hyperactivity is demonstrated by the fact that all antipsychotic agents are dopamine D2 antagonists and from the fact that illicit drugs such as amphetamines and cocaine, which are dopaminergic drugs, can cause psychotic symptoms. The other options are neuronal findings for other diagnoses: look them up!

 

11. A. The correct answer is Alzheimer’s Disease. Alzheimer’s dementia is the most likely diagnosis as she appears to have memory impairment, consciousness is not impaired, and other causes have been excluded. However, it is important to obtain a collateral history and brain imaging may help to confirm the diagnosis. The main differential is that of delirium, which is marked with fluctuating consciousness. Vascular is less likely, in the absence of vascular risk factors.

 

12. A.  Acamprosate acts by enhancing GABA transmission in the brain by blocking the NMDA glutamate receptors, with the aim of reducing alcohol cravings. There is evidence to suggest that acamprosate can increase the rates of abstinence.Chlordiazepoxide (a benzodiazepine similar to diazepam) is given to relieve alcohol withdrawal symptoms and to prevent alcohol withdrawal seizures.  Naltrexone is a competitive antagonist at the kappa- and mu-opioid receptors used as an aid in remaining abstinent from opiates by blocking opiate intake. In alcohol dependency, it reduces the ‘highs’ associated with drinking. Disulfiram (antabuse) blocks the pathway by which alcohol is broken down by the enzyme acetaldehyde dehydrogenase, resulting in the build-up of acetaldehyde with alcohol consumption. This leads to unpleasant effects such as flushing, nausea, and headaches and the aim is to associate drinking alcohol with these effects. Lofexidine is an alpha-adrenergic (alpha-2) agonist used to minimise opiate withdrawal symptoms such as sweating and lacrimation. 

 

 

13. A. The correct answer is akasthisia. This is most likely as he has recently started antipsychotic medication. You should however take a full alcohol history and exclude symptoms of alcohol withdrawal. You should also exclude another possible organic cause.It is unlikely that he has clinical anxiety or depressive features if his distress is all relating to these symptoms. However, never assume so you should assess his mental state fully as well.Akathisia is a common side effect of antipsychotics (especially typicals) and presents with motor restlessness. Differential diagnoses include generalised anxiety disorder and substance misuse. You should be familiar with all the main side effects of antipsychotic medication (especially extra-pyramidal side effects). Look them up if you’re not sure!

 

14. C. The correct answer is cannabis intoxicaton. You should not jump to conclusions about this being a psychiatric diagnosis (such as a first psychotic episode) as the symptoms could be very brief and all in relation to recent drug use. Exclude this first as it is more likely. Cannabis intoxication is the most likely diagnosis given his paranoid ideations and physical signs such as red eyes. The main differential diagnosis is cocaine intoxication, in which patients can present with grandiose ideations and tachycardia. 

 

 

15. E. The correct answer is Organic Delusional Disorder. This is an example of an organic delusional disorder triggered by an exacerbation of Crohn’s disease and use of high-dose steroids. Steroids can trigger mania and psychosis in previously well individuals. The answer is not delirium- as her consciousness is intact with no suggestions of fluctuating symptoms. A diagnosis of an acute and transient psychotic disorder is also ruled out due to the presence of an organic aetiology. 

 

16. B. The correct answer is Hypochondriasis. Hypochondriasis is the persistent preoccupation of having a serious physical disorder or the preoccupation with a presumed deformity or disfigurement (body dysmorphic disorder). The symptoms cause distress and lead the patient to seek medical treatment or investigations, but there is a refusal to accept reassurance. 

 

17. C. The correct answer is Depression with psychotic features. Depression in older patients may not present with low mood. Mood congruent delusions such as delusions of guilt, poverty, nihilism, and hypochondriasis occur in depression. The psychosis is unlikely to resolve (even with antipsychotic medication) unless the depression is treated. Management should include medication but should involve the bio-psycho-social model. The lack of Schneider first-rank symptoms (look these up if you can’t remember these) distinguishes this from schizophrenia and schizoaffective disorder. 

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Last updated March 2020

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