MRCPsych Clinical Procedures and Protocols 3 — Questions and Answers
Question 1: A 35-year-old woman with bipolar disorder presents in labour. Her lithium level was 0.8 mmol/L last week. What is the most appropriate management of lithium during labour?
- Continue lithium at the same dose throughout labour
- Withhold lithium during labour and restart postpartum (Correct answer)
- Switch to valproate immediately
- Double the lithium dose to account for renal changes
Correct answer: Withhold lithium during labour and restart postpartum
Lithium should be withheld during labour due to rapid fluid shifts and risk of toxicity, then restarted postpartum once the patient is stable and able to eat and drink.
Question 2: Which scale is specifically used to monitor tardive dyskinesia in patients on long-term antipsychotics?
- PANSS
- AIMS (Correct answer)
- BPRS
- CGI
Correct answer: AIMS
The Abnormal Involuntary Movement Scale (AIMS) is the standard tool for assessing and monitoring tardive dyskinesia in psychiatric practice.
Question 3: Under the UK's Deprivation of Liberty Safeguards (DoLS), which of the following settings does DoLS specifically apply to?
- Prisons and secure units only
- Hospitals and care homes (Correct answer)
- Community psychiatric teams
- All settings including the patient's own home
Correct answer: Hospitals and care homes
DoLS applies specifically to hospitals and care homes in England and Wales; for other settings, a Court of Protection order is required.
Question 4: A patient with treatment-resistant depression is being considered for repetitive transcranial magnetic stimulation (rTMS). Which brain region is most commonly targeted?
- Right dorsolateral prefrontal cortex
- Left dorsolateral prefrontal cortex (Correct answer)
- Anterior cingulate cortex
- Occipital cortex
Correct answer: Left dorsolateral prefrontal cortex
High-frequency rTMS is typically applied to the left dorsolateral prefrontal cortex (DLPFC) to treat depression by increasing activity in that region.
Question 5: When using the PHQ-9 to screen for depression, what score indicates moderately severe depression?
- 5–9
- 10–14
- 15–19 (Correct answer)
- 20–27
Correct answer: 15–19
PHQ-9 scores of 15–19 correspond to moderately severe depression; scores of 20–27 indicate severe depression.
Question 6: In rapid tranquillisation of an agitated patient who is not responding to oral medication, which intramuscular combination is recommended by NICE (NG10)?
- IM lorazepam alone
- IM haloperidol plus IM promethazine (Correct answer)
- IM diazepam plus IM haloperidol
- IM olanzapine plus IM lorazepam
Correct answer: IM haloperidol plus IM promethazine
NICE guideline NG10 recommends IM haloperidol combined with IM promethazine for rapid tranquillisation, noting that IM lorazepam and IM olanzapine should not be combined.
Question 7: A patient lacks capacity and requires an urgent blood transfusion. No advance decision exists and no welfare attorney has been appointed. Who makes the decision?
- The nearest relative
- The senior nurse on duty
- The responsible clinician acting in the patient's best interests (Correct answer)
- The hospital ethics committee
Correct answer: The responsible clinician acting in the patient's best interests
Under the Mental Capacity Act 2005, when a patient lacks capacity and no proxy decision-maker exists, the responsible clinician must act in the patient's best interests.
MRCPsych Clinical Procedures and Protocols 3
A 35-year-old woman with bipolar disorder presents in labour.
Her lithium level was 0.8 mmol/L last week.
What is the most appropriate management of lithium during labour?