Mental Health1. A 41-year-old man has more severe depression with marked anhedonia, early-morning wakening and declining work function for 10 weeks. He prefers a medicine after discussion of psychological options. There is no history of hypomania. What is the most appropriate first-line antidepressant class in UK primary care? Select TWO correct statements.Select all that apply.A. Most appropriate: A selective serotonin reuptake inhibitorB. The following is not the most appropriate next step: A tricyclic antidepressant such as amitriptylineC. Most appropriate: A monoamine oxidase inhibitor such as phenelzineD. Most appropriate: An antipsychotic such as quetiapine for moodCheck
Mental Health2. A 34-year-old woman describes 3 weeks of low mood. She also reports a fortnight last year of needing almost no sleep, spending excessively and feeling unusually creative, after which her GP noted pressured speech. What is the most appropriate next prescribing decision?A. Do not start antidepressant monotherapy and refer to specialist bipolar servicesB. Start citalopram 20 mg and review in 2 weeks as for unipolar depressionC. Start amitriptyline at night to help sleep and mood togetherD. Start quetiapine 25 mg at night in primary care as mood stabilisationCheck
Mental Health3. A 38-year-old woman has generalised anxiety disorder causing daily worry and muscle tension. Low-intensity psychological treatment has not helped. She wants a medicine and is not pregnant. Which drug does NICE recommend first if pharmacotherapy is used? The most appropriate action is: SertralineTRUE. TrueFALSE. FalseCheck
Mental Health4. A 33-year-old woman is 6 days post-partum. Her partner reports she has not slept, believes the baby is possessed, and is packing to flee. She appears perplexed. What is the most appropriate next step?A. Start sertraline in the surgery and review at the 6-week postnatal checkB. Reassure that baby blues peak at day 5 and usually settle without treatmentC. Ask health visiting to call next working day for a mood screenD. Emergency psychiatric assessment the same day, keeping mother and infant safeCheck
Mental Health5. A 52-year-old man with alcohol dependence wants a medically assisted community withdrawal. He has no history of withdrawal seizures or delirium, a supportive partner, and normal bloods. What is the most appropriate pharmacological regimen if community detoxification proceeds?A. Disulfiram started on day 1 of cessation to enforce abstinenceB. A reducing course of chlordiazepoxide (or diazepam) with thiamineC. Naltrexone as monotherapy to cover the first 5 days of withdrawalD. A reducing course of sertraline for the anxiety of early abstinenceCheck
Mental Health6. A 77-year-old woman has 12 months of progressive short-term memory loss affecting shopping and bills. She is otherwise well. Confusion screen bloods are normal. What is the most appropriate next step?A. Start donepezil 5 mg in general practice todayB. Diagnose Alzheimer's disease in GP and code without further assessmentC. Refer routinely to old-age psychiatry only if she becomes a risk to othersD. Refer to a memory assessment serviceCheck
Mental Health7. A 68-year-old man with treated depression decides to give large gifts that will leave him short of money. He can explain the options, risks and his reasons. Staff think the choice is foolish. What is the correct capacity conclusion under the Mental Capacity Act 2005?A. He lacks capacity because the decision is objectively unwiseB. He has capacity for this decision if the two-stage test is metC. Depression means he automatically lacks capacity for financial decisionsD. An IMCA must be instructed before any gift is allowedCheck
Mental Health8. Which statement about the Mental Health Act in England and Wales is correct? Select TWO correct statements.Select all that apply.A. Most appropriate: A person who has decision-making capacity may still be detained if MHA criteria are metB. The following is not the most appropriate next step: Detention is only lawful if a doctor has already proved lack of capacity under the MCAC. Most appropriate: The MHA is used mainly to compel antibiotics for pneumonia in people who also have depressionD. Most appropriate: Sectioning automatically authorises all medical treatments, including surgeryCheck
Mental Health9. A 61-year-old woman has taken diazepam 10 mg nightly for 8 years for insomnia. She agrees to stop. What is the most appropriate strategy?A. Stop tonight and offer melatonin 2 mg as coverB. Switch to zopiclone at an equivalent dose long termC. Switch to quetiapine 25 mg nightly as a safer hypnoticD. Convert if needed and reduce the dose gradually over weeks to monthsCheck
Mental Health10. A 46-year-old man has chronic insomnia for 9 months. Alcohol is modest, depression screen is negative, and the history does not suggest sleep apnoea. What is the most appropriate first-line treatment?A. Cognitive behavioural therapy for insomniaB. Temazepam for 3 months then reviewC. Amitriptyline 10 mg as routine first-lineD. Modified-release melatonin as standard NHS care in working-age adultsCheck