Multiple Choice Questions MCQ

Question 23# Print Question

A 54-year-old man with a history of depression presents for review. He was started on fluoxetine eight weeks ago and is now requesting to stop his medication as he feels so well.

What should be recommended regarding his treatment?

A. It should be stopped straight away

B. It should be continued for at least another 6 weeks

C. It should be continued for at least another 3 months

D. It should be continued for at least another 6 months

E. It should be continued for at least another 12 months

Correct Answer D: This greatly reduces the risk of relapse. Patients should be reassured that antidepressants are not addictive.

Depression: selective serotonin reuptake inhibitors:

Selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatment for the majority of patients with depression.

Citalopram and fluoxetine are currently the preferred SSRIs
Citalopram is useful for elderly patients as it is associated with lower risks of drug interactions
Sertraline is useful post myocardial infarction as there is more evidence for its safe use in this situation than other antidepressants
SSRIs should be used with caution in children and adolescents. Fluoxetine is the drug of choice when an antidepressant is indicated

Adverse effects:

Gastrointestinal symptoms are the most common side-effect
There is an increased risk of gastrointestinal bleeding in patients taking SSRIs. A proton pump inhibitor should be prescribed if a patient is also taking a NSAID
Patients should be counseled to be vigilant for increased anxiety and agitation after starting a SSRI
Fluoxetine and paroxetine have a higher propensity for drug interactions
Citalopram and sertraline and more suitable for patients with chronic physical health problems as they have a lower propensity for drug interactions

Interactions:

NSAIDs: NICE guidelines advise 'do not normally offer SSRIs', but if given co-prescribe a proton pump inhibitor
Warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
Aspirin: see above
Triptans: avoid SSRIs

Following the initiation of antidepressant therapy patients should normally be reviewed by a doctor after 2 weeks.

For patients under the age of 30 years or at increased risk of suicide they should be reviewed after 1 week. If a patient makes a good response to antidepressant therapy they should continue on treatment for at least 6 months after remission as this reduces the risk of relapse.

When stopping a SSRI the dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine). Paroxetine has a higher incidence of discontinuation symptoms.

Discontinuation symptoms:

Increased mood change
Restlessness
Difficulty sleeping
Unsteadiness
Sweating
Gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
Paraesthesia

Question 21# A 45-year-old man is admitted due to haematemesis. He drinks 120 units of alcohol a week. When is the peak incidence of seizures following alcohol withdrawal?
A. 2 hours
B. 6 hours
C. 12 hours
D. 24 hours
E. 36 hours
Correct Answer E: Alcohol withdrawal: Mechanism: Chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors Alcohol withdrawal is thought to be lead to the opposite (decreased inhibitory GABA and increased NMDA glutamate transmission) Features: Symptoms start at 6-12 hours Peak incidence of seizures at 36 hours Peak incidence of delirium tremens is at 72 hours Management: Benzodiazepines Carbamazepine also effective in treatment of alcohol withdrawal Phenytoin is said not to be as effective in the treatment of alcohol withdrawal seizures

Question 22# Which of the following conditions is least associated with obsessive compulsive disorder?
A. Tourette's syndrome
B. Anorexia nervosa
C. Schizophrenia
D. Depression
E. Wilson's disease
Correct Answer E: Obsessive Compulsive Disorder OCD: Pathophysiology: Some research suggest childhood group A beta-haemolytic streptococcal infection may have a role Associations: Depression (30%) Schizophrenia (3%) Sydenham's chorea Tourette's syndrome Anorexia nervosa

Question 24# Which one of the following is not associated with a poor prognosis in schizophrenia?
A. Acute onset
B. Strong family history
C. Low IQ
D. Premorbid history of social withdrawal
E. Lack of obvious precipitant
Correct Answer A: A gradual, rather than acute, onset is associated with a poor prognosis. Schizophrenia: prognostic indicators: Factors associated with poor prognosis: Strong family history Gradual onset Low IQ Premorbid history of social withdrawal Lack of obvious precipitant

Question 25# A 24-year-old female is reviewed following a course of cognitive behaviour therapy for bulimia. She feels there has been no improvement in her condition and is interested in trying pharmacological treatments. Which one of the following is most suitable?
A. Low-dose citalopram
B. Low-dose fluoxetine
C. Low-dose amitriptyline
D. High-dose amitriptyline
E. High-dose fluoxetine
Correct Answer E: Bulimia nervosa is a type of eating disorder characterized by episodes of binge eating followed by intentional vomiting. Bulimia nervosa Management: Referral for specialist care is appropriate in all cases Cognitive behaviour therapy (CBT) is currently consider first-line treatment • interpersonal psychotherapy is also used but takes much longer than CBT Pharmacological treatments have a limited role - a trial of high-dose fluoxetine is currently licensed for bulimia but long-term data is lacking

Question 23# A 54-year-old man with a history of depression presents for review. He was started on fluoxetine eight weeks ago and is now requesting to stop his medication as he feels so well. What should be recommended regarding his treatment?
A. It should be stopped straight away
B. It should be continued for at least another 6 weeks
C. It should be continued for at least another 3 months
D. It should be continued for at least another 6 months
E. It should be continued for at least another 12 months
Correct Answer D: This greatly reduces the risk of relapse. Patients should be reassured that antidepressants are not addictive. Depression: selective serotonin reuptake inhibitors: Selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatment for the majority of patients with depression. Citalopram and fluoxetine are currently the preferred SSRIs Citalopram is useful for elderly patients as it is associated with lower risks of drug interactions Sertraline is useful post myocardial infarction as there is more evidence for its safe use in this situation than other antidepressants SSRIs should be used with caution in children and adolescents. Fluoxetine is the drug of choice when an antidepressant is indicated Adverse effects: Gastrointestinal symptoms are the most common side-effect There is an increased risk of gastrointestinal bleeding in patients taking SSRIs. A proton pump inhibitor should be prescribed if a patient is also taking a NSAID Patients should be counseled to be vigilant for increased anxiety and agitation after starting a SSRI Fluoxetine and paroxetine have a higher propensity for drug interactions Citalopram and sertraline and more suitable for patients with chronic physical health problems as they have a lower propensity for drug interactions Interactions: NSAIDs: NICE guidelines advise 'do not normally offer SSRIs', but if given co-prescribe a proton pump inhibitor Warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine Aspirin: see above Triptans: avoid SSRIs Following the initiation of antidepressant therapy patients should normally be reviewed by a doctor after 2 weeks. For patients under the age of 30 years or at increased risk of suicide they should be reviewed after 1 week. If a patient makes a good response to antidepressant therapy they should continue on treatment for at least 6 months after remission as this reduces the risk of relapse. When stopping a SSRI the dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine). Paroxetine has a higher incidence of discontinuation symptoms. Discontinuation symptoms: Increased mood change Restlessness Difficulty sleeping Unsteadiness Sweating Gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting Paraesthesia

Your-Doctor Multiple Choice Questions (MCQ)

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Multiple Choice Questions (MCQ)