Q1. Which feature most suggests DELIRIUM rather than a primary psychotic illness? A. Auditory hallucinations B. Acute onset with a fluctuating, clouded conscious level C. Clear sensorium D. Gradual onset over months ANSWER: B. Why: delirium is defined by acute onset, fluctuation and impaired attention with clouded consciousness. Primary psychosis usually develops more gradually with a clear sensorium. LEARNING POINT: prominent VISUAL hallucinations also point toward an organic cause.

Q2. Asking a patient directly about suicidal thoughts: A. Increases the risk by suggesting the idea B. Does not increase risk and is an essential part of assessment C. Should only be done by a psychiatrist D. Should be avoided if the patient seems calm ANSWER: B. Why: the belief that asking plants the idea is unfounded. Direct enquiry is the single most important element of risk assessment and is often experienced as a relief. LEARNING POINT: ask directly, in private, and document the answer in the patient's words.

Q3. An 82-year-old becomes agitated two days after hip surgery. The FIRST action should be: A. Prescribe intramuscular sedation B. Assess for reversible causes — glucose, hypoxia, pain, retention, infection, drugs C. Refer to psychiatry D. Apply physical restraint ANSWER: B — look for reversible causes. Why: this is delirium until proven otherwise. Urinary retention, pain, constipation, hypoxia, infection and recent drugs are common, treatable and easily found. A: sedating without assessment leaves the cause untreated and adds risk. LEARNING POINT: agitation is a symptom, not a diagnosis.

Q4. A young woman is medically fit after a small overdose and asks to leave. The correct action is: A. Discharge — she is medically cleared B. Psychosocial assessment before discharge, with follow-up arranged C. Admit under mental health legislation automatically D. Discharge with a leaflet ANSWER: B. Why: every episode of self-harm requires psychosocial assessment before discharge. Medical clearance addresses the physical consequences, not the reason for the act, and previous self-harm is a strong predictor of later suicide. LEARNING POINT: low medical lethality does not mean low risk.

Q5. A patient on an antipsychotic develops, over three days, fever, generalised rigidity, autonomic instability and a markedly raised creatine kinase. The diagnosis is: A. Serotonin syndrome B. Neuroleptic malignant syndrome C. Malignant hyperthermia D. Alcohol withdrawal ANSWER: B — NMS. Why: antipsychotic exposure, onset over DAYS, lead-pipe rigidity, hyperthermia and raised CK. A: serotonin syndrome develops over HOURS with clonus and hyperreflexia rather than rigidity. LEARNING POINT: time course and tone are the discriminators.

Q6. A malnourished patient with alcohol dependence is hypoglycaemic and confused. Regarding treatment: A. Give glucose alone B. Give thiamine first or alongside glucose, without delaying treatment of hypoglycaemia C. Withhold glucose until thiamine levels return D. Give neither until imaging is done ANSWER: B. Why: glucose metabolism consumes thiamine, and a glucose load in a deficient patient can precipitate Wernicke's encephalopathy. But hypoglycaemia itself is dangerous, so glucose is not withheld — thiamine is given first or alongside. LEARNING POINT: the sequence matters, but neither drug is delayed waiting for the other.

Q7. Which intervention has the strongest evidence for reducing suicide risk at a population level? A. Risk scoring tools B. Restricting access to means C. Routine admission of all patients who self-harm D. Antidepressants for everyone assessed ANSWER: B — restricting access to means. Why: means restriction is among the most effective interventions available, because many suicidal crises are time-limited and impulsive. A: risk scores perform poorly at predicting individuals. C: admission is not universally protective and is not appropriate for every patient. LEARNING POINT: a practical conversation about what is available at home is part of the plan, not an afterthought.