Mental Health 10 Single Best Answer (SBA)
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1. A 10-year-old boy is brought to the clinic with difficulties in concentration, hyperactivity, and impulsivity both at home and in school. What is the first-line treatment for ADHD in children?
Answer: Behavioural therapy
Behavioural therapy is first-line for mild ADHD in children, with stimulant medication (like methylphenidate) reserved for more significant or persistent symptoms.
2. What is the most common early presentation of autism spectrum disorder in toddlers?
Answer: Delayed speech and language development
Speech and language delays are commonly the first symptoms prompting parents to seek evaluation for possible autism.
3. A 25-year-old man is admitted to the mental health ward with auditory hallucinations and paranoid delusions. He is agitated and unable to maintain a coherent conversation. What is the most appropriate initial management?
Answer: Administer intramuscular haloperidol and lorazepam
For severe agitation in acute psychosis, a rapid-acting antipsychotic and a benzodiazepine help stabilise the patient. Oral meds come later once agitation subsides.
4. A 50-year-old woman reports her neighbours are conspiring to harm her but denies hallucinations or bizarre behaviour. What is the most likely diagnosis?
Answer: Delusional disorder
Delusional disorder presents with persistent delusions, often persecutory, but without hallucinations, negative symptoms, or functional decline seen in schizophrenia.
5. What is the most common complication associated with dissociative identity disorder?
Answer: Self-harming behaviour
Dissociative identity disorder often involves severe trauma backgrounds, leading to emotional turmoil and increased risk of self-harm.
6. What is the primary mechanism of addiction in substance misuse?
Answer: Activation of the brain's reward system through dopamine release
Addictive drugs hijack the mesolimbic dopamine pathway, reinforcing drug-seeking and use.
7. A 32-year-old woman at 28 weeks gestation presents with severe depression and suicidal thoughts. What is the most appropriate initial management?
Answer: Admit to mental health unit
Suicidal ideation in pregnancy warrants close supervision and urgent mental health intervention in a specialised unit if available.
8. A 75-year-old man with Parkinson’s disease presents with cognitive decline, visual hallucinations, and fluctuating levels of consciousness. What is the most likely diagnosis?
Answer: Dementia with Lewy bodies
Fluctuating attention, visual hallucinations, and motor Parkinsonism strongly suggest dementia with Lewy bodies.
9. What is the most effective first-line treatment for chronic insomnia?
Answer: Cognitive behavioural therapy for insomnia (CBT-I)
CBT-I addresses maladaptive sleep habits and thoughts, showing long-lasting efficacy over medication for chronic insomnia.
10. A 22-year-old man with OCD refuses therapy, stating he is not ready to change his compulsions. He has capacity and poses no immediate harm. What is the most appropriate next step?
Answer: Respect his decision and offer psychoeducation
Autonomy is paramount if the patient is competent and not a danger to self or others. Provide psychoeducation and remain available if he changes his mind.
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