Psychiatry 1 MCQs

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A person with Avoidant personality disorder is socially withdrawn but actually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

Answer

Organic causes for mental disorder are more likely in all the following
EXCEPT those with

Visual hallucinations

A family history of psychiatric illness

Onset in the last 2 days

Age >30 years

Answer

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

Answer

With regards to drugs used for chemical restraint , which is FALSE?

Midazolam has a half-life of 2 hours

Diazepam has a half-life of 43 hours

Droperidol has no anti-psychotic properties

Extrapyramidal side-effects are commoner with droperidol than haloperidol.

Answer

Which of the following is NOT an axis 1 diagnosis

Munchausens

Dementia

Anorexia nervosa

Intellectual retardation

Answer

Which of the following is an easily reversible cause of dementia?

Myxoedema

Alzheimers

Korsakoffs

Huntingtons

Answer

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

Answer

With regard to psychiatric illness

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

Answer

Which is associated with a relatively lower suicide completion risk?

Elderly male

Schizophrenia

Amphetamine abuse

Personality disorder

Answer

10

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?

Discharge home

Admit under Duty of Care

Admit under Form I of the Mental Health Act

Admit under Form III of the Mental Health Act

Answer

11

Which of the following suggest a low risk for suicide at the time of interview?

Helplessness

Refusal to provide additional information

Remorse regarding suicide attempt

Exhaustion

Answer

12

Which is FALSE?

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

Answer

13

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.

C
D

A subsequent convulsion does not clarify the mot likely antidepressant

taken.
A co-ingestion of benzodiazepine is likely to worsen her outcome.

Answer

14

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.

Answer

15

Which of the following is TRUE regarding Bipolar affective disorder?

Rapid Cyclers have 5 or more episodes of mania and depression per year.

Male : Female incidence is equal

Criteria include poor self esteem and flight of ideas

Most patients with a manic state do not have Bipolar affective disorder

Answer

16
The leading cause of death in Australia in the under 30s is
A

Trauma

Cancer

Suicide

Congenital disease

Answer

17

Patients with schizophrenia typically complain of:

Formication

Visual hallucinations

Pressure of speech

Voices arguing about them

Answer

18
Which feature is MOST consistent with an acute psychotic illness?
A

Focal neurological signs

Disordered speech or behaviour

Impaired cognition

Fluctuating mental state

Answer

19
In regard to Phobias & Panic disorders, which statement is FALSE?
A

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.

Answer
20
All of the following have been associated with neuroleptic malignant
syndrome EXCEPT :
A

Nortriptyline

Olanzipine

Organic brain disease

Haloperidol

Answer
21
With regard to extrapyramidal movement disorders
A

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

Answer

22

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

Answer

23

Which statement regarding Doxepin overdose is FALSE?

Its anti-histamine effects are more marked than most other TCA drugs.

TCAs 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

Answer

24

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

Answer

25

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?

Pethidine

Citalopram

Well ripened cheese ingestion 3 days earlier

Cold and flu tablets containing Pseudoephedrine

Answer

26

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

Answer

27

Olanzapine acts at which of the following receptors?

5HT2

D2

M1

All of above

Answer

28

Atypical antipsychotics are associated with increased mortality in?

Elderly patients

Type 2 Diabetics

Patients with heart disease

All of the above

Answer

29

Which would NOT be expected in 3g Venlafaxine overdose in adult?

Torsades de pointes

Serotonin syndrome

Asymptomatic

Seizures

Answer

30

Which of the following is NOT a side effect of Sertraline use?

Hyponatraemia

Decreased libido

Weight gain

Constipation

Answer

31

Risk factors for increased toxicity of lithium include all the following
EXCEPT.

Dehydration from any cause

diuretics

Theophylline

Low sodium

Answer

32

Which of the following is found in anorexia nervosa?

Lower mortality in bulimics compared with pure anorexics.

hyperkalaemia

Decreased aldosterone

Prolonged QT, SVT and dysrhythmias

Answer

33

Which of the following is FALSE with regards to Schizophrenia?

It is characterized by loosening of associations, auditory hallucinations and

delusions

It has a 10-15% lifetime suicide risk

Relapse is commonly associated with non-compliance with medications

Hallucinations are required to make a diagnosis

Answer

34

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

Answer

35

Which of the following is NOT a feature of Delirium?

Visual hallucinations

Tactile hallucinations

Auditory hallucinations

Determination of a pathogenic cause is required

Answer

36

Side effects of Lithium use include

Fine tremor

Coarse tremor

Weight loss

Thirst

Answer

37

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

Answer

38

Which of the following is INCORRECT regarding panic attacks

May present with carpopedal spasm

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

Answer

39

Medications that are known to be significantly associated with depression

include all of the following EXCEPT:

phenytoin

oral contraceptives

digoxin

isotretinoin

Answer

40

Medical conditions that are associated with depression include all of the
following EXCEPT:

hypocalcaemia

lung carcinoma

stroke

pancreas carcinoma

Answer

41

Which of the following is uncommon in delirium

Illusions or misinterpretations

Structured delusions

A fluctuating course

Abrupt onset

Answer

42

Which antidepressant class is INCORRECT

Citalopram serotonin and noradrenaline reuptake inhibitor

Mirtazapine noradrenaline and selective serotonin antagonist

Sertraline selective serotonin reuptake inhibitor

Moclobemide reversible monoamine oxidase inhibitor

Answer

43

Schizophrenia

Has a 20yr suicide rate of up to 22%

Is typically associated with olfactory hallucinations

Is more common in males

Has a prevalence of 1-2% of the population

Answer

44

Which of the following is a NOT a high risk factor for suicide in Australia?

Personality disorder

Schizophrenia

Female sex

Aboriginal

Answer

45
A

Which of these patients would MOST appropriately be assigned an ATS2

triage category?
An aggressive patient wielding a knife.

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.

Answer

46

Which is TRUE regarding suicide:

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.

Answer

47

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

Answer

Answers
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.

B
D
D
D
D
A
C
C
D
B
C
B
D
B
B
C
D
B
C
A
B
C
D
B
C
C
D
D
A
C
C
D
D

34.
35.
36.
37.
38.
39.
40.
41.
42.
43.

A
D
C
D
D
A
A
B
A
A

44. C
45. D
46. B
47. A

(theo increases clearance of lithium. causes cardiac abnormalities = Ebsteins

No hallucinations in Catatonic (waxy flexibility, mute, rigidity and hypertonic) and
Disorganized schizophrenia

Dunn
Dunn
rd
Textbook of Adult Emergency Medicine (Cameron et al.), 3 ed., p.637
rd
Textbook of Adult Emergency Medicine (Cameron et al.), 3 ed., p.637
Cameron, page 623
Trevors notes
B auditory hallucinations, C male:female 1:1, D prevalence 0.2-0.5%
Cameron Ch 20.5
males higher risk for successful suicide (except China) Cameron Chapter
20.3
Dunn p833 (A: ATS1, B: ATS4or5, C: ATS3or4, D: ATS 2 due to hallucinations)
Dunn p843 (leading cause, men are more successful but women are more likely to
attempt, pts commonly seek help prior to suicide)
rd
Cameron (3 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