The Mind

Multiple Choice

A 26-year-old woman comes into the GP surgery looking tearful. She says that she is struggling to cope and feels unable to eat and sleep. She reports feeling exceptionally low and often cries. Her past medical history is unremarkable.

You suspect a diagnosis of depression. Which of the following blood tests is most appropriate initially in this patient?

• Short synacthen test.

• Serum BHcG.

• Thyroid function test

• Serum cortisol.

• Tumour marker panel.

Multiple Choice

A 50 year old man attends the GP for a mental health review. He was diagnosed with moderate depression two months ago after losing his job and has been taking Sertraline since then. He tells you he feels much better now, he is eating and sleeping well, and that he is finally ready to stop taking medication. He no longer has thoughts of self-harm, and he has started looking for work. You concur that his mood is much improved in clinic today.

What is the most appropriate advice to give regarding cessation of treatment?

• Stop Sertraline today

• It is likely patient will need to continue Sertraline for life.

• Continue Sertraline for a further six months.

• Continue Sertraline for a further three months.

• Trial stopping Sertraline for two weeks and review

Multiple Choice

A 22-year-old lady presents to the GP with low mood. She explains that she has been feeling down, and is tired all the time, despite sleeping more. During the consultation she becomes tearful and explains this started 2 months ago after the breakdown of her long-term relationship. She also started a new course at university and feels stressed about her workload but is still able to concentrate on and complete her assignments. Her appetite is the same, and she still enjoys visiting her friends. She denies any thoughts of harming herself. What is the most appropriate management?

• Refer for high-intensity psychological intervention in the form of individual CBT.

• Exercise and healthy eating advice, with follow up in 1 month to check progress

• Start sertraline and review in two weeks.

• Start mirtazapine and review in two weeks.

• Refer for individual guided self-help or group-based cognitive behavioural therapy (CBT).

Multiple Choice

A 32-year-old female has been admitted to A&E after being found wandering around the town barefoot. She is found mumbling a constant stream of words, none of which make sense or have any context to the situation she is in. She does not tell the officers her name but can be led to a car and allows the officers to help her in.

What section of the Mental Health Act (MHA) can be used to move the patient against their wishes to a place of safety?

• Section 3

• Section 5(2) of the MHA

• Section 4

• Section 136

• Section 2

Multiple Choice

A 24 year old woman who presented with a first instance of mania has been treated with an anti-psychotic for several months. She has responded well, and a diagnosis of Bipolar Disorder has been made. The psychiatrist now wishes to instigate maintenance therapy.

What is the most appropriate initial maintenance treatment for this patient?

• Lithium and citalopram

• Sodium Valproate

• Lithium

• Risperidone

• Lithium and risperidone

Multiple Choice

A 24 year old man, who has not had any previous contact with mental health services, presents to his GP saying he has been hearing voices for the last two months. The voices comment on his behaviour as he goes about his daily routine and can be derogatory in nature. He is certain that other people are putting thoughts into his mind and he cannot be persuaded otherwise.

 What is the most appropriate first-line treatment?

• Clozapine

• Haloperidol

• Lorazepam

• Sertraline

• Risperidone

Multiple Choice

•A 39-year-old man presents to A&E saying that he feels unwell. He appears drowsy and confused. On further questioning he admits to having taken a substance but will not disclose what. On examination his vital observations are: pulse 40bpm, respiratory rate 10/min, temperature 37.0 degrees, BP 126/84, O2 sats 98% on room air. He has constricted pupils and there is evidence of needle marks in his left antecubital fossa. Which receptor is the substance he has taken most likely to be acting on?

• Cannaboid receptor

• Dopamine receptor

• TAAR1 receptor

• GABA receptor

• Opiod receptor

Multiple Choice

A 27-year-old man attends the emergency department when he was found wandering the streets at night. Although he is usually a heavy drinker, he has not had anything at all for the past three days due to running out of money.

On examination, he is responding to unseen stimuli, and is visibly sweaty and trembling. He is disoriented to time and place.

Which of the following is the most appropriate first line management?

• Oral olanzapine

• IV phenytoin

• Oral lorazepam

• Oral phenytoin

• IM haloperidol

Multiple Choice

A 55 year old female is admitted to the intensive care unit with sepsis. She has a five day history of feeling generally unwell. Her urea is 16.5 (2.5-10.7 mmol/L) and creatinine is 176 (60-120 umol/L).

Which of the following findings should prompt consideration for haemofiltration?

• U waves on ECG

• Bibasal crackles on auscultation

• Hyponatraemia

• Metabolic alkalosis

• Hypoglycaemia

Multiple Choice

A 55-year-old man presents to the GP for a routine blood test. He is currently asymptomatic. He has a past medical history of type 2 diabetes mellitus, hypercholesterolaemia and is overweight. He drinks one bottle of wine each week. Examination is unremarkable. Blood tests are as follows:

FBC, Us&Es, CRP: all normal 

Bilirubin 15μmol/L (<21μmol/L) 

ALT 120U/L (<41U/L), 

AST 100U/L (5-40U/L) 

ALP 87U/L (30-130U/L) 

Albumin 40g/L (35-50g/L)

Which of the following is the most likely cause of this patient’s blood results?

• Autoimmune hepatitis

• Drug-induced liver disease

• Chronic hepatitis C infection

• Non-alcoholic fatty liver disease (NAFLD)

• Alcoholic liver disease

Multiple Choice

A 49 year old gentleman presents with jaundice, feeling generally unwell and vague abdominal discomfort. The patient complains that he has recently noticed developing abnormal stools which are pale, float and are difficult to flush away. His past medical history includes several episodes of acute pancreatitis secondary to alcohol misuse. His bloods reveal:

Bilirubin 59mmol/L (3-17)

AST 220mU/L (3-35)

ALT 188mU/L (3-35)

ALP 152mU/L (30-150)

Albumin 20g/L (35-50)

What type of jaundice is this gentleman most likely to have presented with?

• Pre-hepatic jaundice

• Neonatal jaundice

• Post-hepatic jaundice

• Hepatic jaundice

• Cholestatic jaundice

Multiple Choice

You are the FY1 on the gastroenterology ward. You are called to assess a 70-year-old man originally admitted for investigation of jaundice, who has started vomiting blood. On examination, he is distressed and continuing to vomit fresh red blood. There is no abdominal tenderness. Further examination is difficult. 

What is the single best initial management option?

• Prothrombin complex concentrate.

• IV fluids

• Transfusion of FFP

• IV terlipressin

Multiple Choice

A 48-year-old man is recovering on the gastroenterology ward after suffering from a large variceal haemorrhage. He is found to have grade II varices on endoscopy, which are banded. Which of the following is recommended with respect to long term prophylaxis against further bleeding?

• Terlipressin

• Spironolactone

• Omeprazole

• Bendroflumethiazide

• Propanolol

Multiple Choice

A first-year medical student attends an Occupational Health appointment to ensure his vaccination record is up to date. He had his Hepatitis B vaccine as a child because he grew up in the Middle East. Which of the following Hepatitis B serology results is in keeping with previous vaccination?

• HbSAg negative, Anti-HbS negative, Anti-HbC negative

• HbSAg positive, Anti-HbS positive, Anti-HbC positive

• HbSAg negative, Anti-HbS positive, Anti-HbC positive

• HbSAg positive, Anti-HbS negative, Anti-HbC positive

• HbSAg negative, Anti-HbS positive, Anti-HbC negative