Mental Health 10 Single Best Answer (SBA)

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Mental Health SBA Quiz

1. A 30-year-old woman reports severe mood swings, irritability, and fatigue in the week before her period. Symptoms resolve completely after menstruation begins. What is the most appropriate first-line treatment?

  • Combined oral contraceptive pill (COCP)
  • Selective serotonin reuptake inhibitor (SSRI)
  • Cognitive behavioural therapy (CBT)
  • Spironolactone

Answer: Selective serotonin reuptake inhibitor (SSRI)

SSRIs address the severe mood and irritability symptoms in PMDD effectively, often with intermittent or continuous dosing strategies.

2. A 45-year-old man presents with a 6-month history of low mood, fatigue, and anhedonia. He denies suicidal ideation. What is the most likely diagnosis?

  • Major depressive disorder (MDD)
  • Dysthymia
  • Bipolar disorder, depressive episode
  • Adjustment disorder

Answer: Major depressive disorder (MDD)

MDD requires at least two weeks of depressive symptoms; here he has 6 months of consistent low mood and anhedonia, meeting criteria.

3. What is the primary pathophysiological abnormality in anorexia nervosa?

  • Hypothalamic-pituitary-adrenal axis dysregulation
  • Reduced caloric intake leading to metabolic and hormonal dysregulation
  • Genetic mutations affecting appetite regulation
  • Chronic inflammation causing weight loss and cachexia

Answer: Reduced caloric intake leading to metabolic and hormonal dysregulation

In anorexia nervosa, persistent undernutrition and weight loss lead to wide-ranging metabolic and endocrine disturbances.

4. A 22-year-old woman with bulimia nervosa has repeated episodes of vomiting. Blood tests show potassium 2.9 mmol/L. What is the most appropriate next step?

  • Prescribe potassium supplementation
  • Initiate cognitive behavioural therapy (CBT)
  • Start a selective serotonin reuptake inhibitor (SSRI)
  • Refer for inpatient admission

Answer: Prescribe potassium supplementation

In bulimia with hypokalaemia, urgent correction of potassium is vital to prevent arrhythmias. Psychological and pharmacological treatments follow.

5. What is the most common long-term complication of untreated binge eating disorder?

  • Obesity and related comorbidities
  • Electrolyte imbalances
  • Social isolation and impaired relationships
  • Severe malnutrition and cachexia

Answer: Obesity and related comorbidities

BED commonly leads to significant weight gain, increasing risk of type 2 diabetes, hypertension, and cardiovascular disease.

6. Which personality disorder is most strongly associated with self-harming behaviours?

  • Borderline personality disorder (BPD)
  • Antisocial personality disorder (ASPD)
  • Narcissistic personality disorder
  • Obsessive-compulsive personality disorder (OCPD)

Answer: Borderline personality disorder (BPD)

Recurrent self-harm or suicidal behaviour is a hallmark of borderline personality disorder.

7. A 35-year-old woman with bipolar disorder presents with severe agitation, pressured speech, and decreased need for sleep. What is the most appropriate initial management?

  • Start oral lithium therapy
  • Administer intramuscular lorazepam
  • Start valproate therapy
  • Arrange for hospital admission

Answer: Administer intramuscular lorazepam

Lorazepam quickly reduces severe manic agitation. Mood stabilisers follow once the patient is calmer. Admission is often required, but sedation is first priority.

8. A 40-year-old man with GAD reports constant worry and insomnia. He declines medication. What is the most appropriate next step?

  • Offer cognitive behavioural therapy (CBT)
  • Prescribe a benzodiazepine for short-term use
  • Start an SSRI immediately
  • Reassure and monitor symptoms

Answer: Offer cognitive behavioural therapy (CBT)

In GAD, CBT is a mainstay if patients refuse pharmacological options. It helps modify thought patterns and reduce worry.

9. Which of the following is a common side effect of SSRIs?

  • Weight gain
  • Sexual dysfunction
  • Bradycardia
  • Hypoglycaemia

Answer: Sexual dysfunction

SSRIs commonly cause sexual side effects (decreased libido, difficulty achieving orgasm).

10. A 25-year-old woman with OCD refuses therapy and insists her rituals are necessary. She demonstrates capacity and is not at immediate risk. What is the most appropriate next step?

  • Respect her decision and provide psychoeducation
  • Insist on starting CBT to address her rituals
  • Refer for involuntary treatment under the Mental Health Act
  • Start SSRI therapy without her consent

Answer: Respect her decision and provide psychoeducation

If a competent patient refuses treatment and poses no significant risk, respect her autonomy. Offer information and support.

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