#Internal_Medicine##MRCP_QBank

72-year-woman was admitted after a fall. She lived alone and worked in the hospital benevolent society shop. You were called to see her because she is agitated, accusing staff of stealing her jewellery and wanting to leave. Which of the following would be your first intervention?

A 23-year-old man, known to have schizophrenia and being prescribed oral trifluoperazine as his only regular medication, was brought to the Emergency Department by ambulance. He was mute, with his head turned to the right in an awkward and extreme position, and he appeared to be distressed. The ambulance crew reported that he had been like this for about 30 minutes. Other than this odd posture, physical examination was normal. Which is the immediate intervention that is most likely to be appropriate?

A 42 year old woman presented in December with a one month history of gradually worsening anhedonia, loss of energy and low mood. Interview was difficult due to her slow speech and poor concentration, but she admitted to derogatory auditory hallucinations telling her she is guilty. She was convinced that she must have committed a terrible crime. Which is the most appropriate diagnosis?

You need to decide which antidepressant to prescribe for an emaciated agitated 78-year-old man who you are seeing as an out-patient. Which one of the following statements is true?

A 30-year-old woman, with a long history of intravenous drug abuse, is admitted with an abscess in her right groin related to the use of non-sterile needles. This is drained, and she is admitted to a medical ward for intravenous antibiotic treatment. She 'goes missing' from the ward at 14.00h, but is found outside a back entrance of the hospital smoking a cigarette at 15.30h and then returns to the ward. At 21.30h you are asked to see her by the ward nurses because she says she feels very unwell. She is nauseated, has had some diarrhoea, and yawns as you talk to her. Her temperature is 37.6 C and her pupils are dilated. The most likely diagnosis is:

A 28-year-old woman with a history of manic depression has been well controlled on lithium for several years. She wishes to get pregnant and asks for advice regarding the safety of lithium in pregnancy and when breast-feeding Which one of the following statements is true?

A 34-year-old woman developed chest pain after an argument with her 17-year-old daughter. She was brought to the Accident and Emergency department where she was hyperventilating and looking very anxious. She was tender to light pressure on the front of her chest, but examination was otherwise unremarkable. Breathing room air, her oxygen saturation (finger probe) was 99%. Her ECG was normal. You should:

A 78-year-old man, without significant past medical history and taking no regular medications, had become increasingly forgetful over the last 18 months, to the point where he now found it difficult to remember the names of some members of his family. He had recently been having visual hallucinations. On examination he seemed rather expressionless and had cogwheel rigidity of both arms. The most likely diagnosis is:

A 48-year-old with recurrent carcinoma of the colon admits to poor sleeping, anhedonia and feelings of hopelessness. Which of the following would you do?

A 22 year old woman had been diagnosed with generalised anxiety disorder following her presentation with a long history of pervasive and continuous symptoms of anxiety. She had been particularly troubled by poor concentration and difficulty getting to sleep. She did not have any concurrent depressive illness or substance misuse. What is the safest and most effective treatment for her generalised anxiety disorder?

Mr Jonas is admitted from his residential home with pneumonia. He is on long-term thioridazine for chronic schizophrenia. Which one of the following statements is true?

A 48-year-old man with a long history of alcohol abuse is admitted after being found collapsed in the street. He is agitated and tremulous. You make a diagnosis of alcohol withdrawal. Which one of the following is appropriate management for this condition?

A 34-year-old woman was brought to the Emergency Department after taking an uncertain quantity of paracetamol two hours previously and trying to hang herself. She became agitated and insisted that she wanted to go home immediately. How should you proceed?

A 40-year-old woman was referred to the general medical clinic with a 9-month history of feeling exhausted. She was unable to do anything that required physical exertion and felt miserable because of this. A comprehensive battery of tests failed to establish any clear medical cause for her symptoms and a diagnosis of chronic fatigue syndrome was made. Which treatment is of definite benefit in this condition?