MRCPsych Emergency Response Procedures 2 — Questions and Answers
Question 1: A patient on an inpatient psychiatric ward becomes acutely agitated and begins throwing objects. The initial de-escalation approach has failed. What is the most appropriate next step according to emergency response guidelines?
- Immediately administer intramuscular haloperidol without further assessment
- Call for additional staff support and attempt verbal de-escalation with increased staffing presence (Correct answer)
- Initiate physical restraint immediately to prevent harm
- Discharge the patient to a general hospital emergency department
Correct answer: Call for additional staff support and attempt verbal de-escalation with increased staffing presence
The recommended approach is to call for additional staff and attempt continued verbal de-escalation before escalating to physical intervention.
Question 2: Under the Mental Health Act, which section allows for the emergency detention of a patient who is already in hospital as an inpatient in a non-psychiatric ward?
- Section 2
- Section 3
- Section 5(2) (Correct answer)
- Section 136
Correct answer: Section 5(2)
Section 5(2) allows a registered medical practitioner to detain an inpatient in any hospital for up to 72 hours for assessment.
Question 3: A psychiatric patient presents to the emergency department with neuroleptic malignant syndrome (NMS). Which feature is NOT typically associated with NMS?
- Hyperthermia
- Muscle rigidity
- Autonomic instability
- Miosis (Correct answer)
Correct answer: Miosis
NMS is characterized by hyperthermia, muscle rigidity, autonomic instability, and altered consciousness — miosis is not a typical feature.
Question 4: In the management of acute lithium toxicity, which intervention is most appropriate for severe toxicity with serum lithium levels >4 mEq/L?
- Activated charcoal administration
- Forced diuresis with furosemide
- Hemodialysis (Correct answer)
- Intramuscular benzodiazepine
Correct answer: Hemodialysis
Hemodialysis is indicated for severe lithium toxicity as it effectively removes lithium from the body.
Question 5: A nurse on a psychiatric ward activates a Section 5(4) holding power. What is the maximum duration this power can be used before a doctor must review the patient?
- 2 hours
- 6 hours (Correct answer)
- 12 hours
- 24 hours
Correct answer: 6 hours
Section 5(4) allows a registered mental health nurse to hold a patient for up to 6 hours until a doctor can attend.
Question 6: During a psychiatric emergency involving serotonin syndrome, which combination of features best differentiates it from NMS?
- Hyperthermia, diaphoresis, and lead-pipe rigidity
- Tremor, clonus, hyperreflexia, and rapid onset (Correct answer)
- Bradycardia, hypotension, and gradual onset
- Metabolic alkalosis and decreased CK
Correct answer: Tremor, clonus, hyperreflexia, and rapid onset
Serotonin syndrome typically presents with clonus, hyperreflexia, tremor, and rapid onset (hours), distinguishing it from the gradual onset and lead-pipe rigidity of NMS.
Question 7: When managing a psychiatric patient who has taken a significant paracetamol overdose, what is the primary antidote used in emergency treatment?
- Flumazenil
- N-acetylcysteine (Correct answer)
- Naloxone
- Sodium bicarbonate
Correct answer: N-acetylcysteine
N-acetylcysteine replenishes glutathione stores and is the primary antidote for paracetamol overdose.
MRCPsych Emergency Response Procedures 2
A patient on an inpatient psychiatric ward becomes acutely agitated and begins throwing objects.
The initial de-escalation approach has failed.
What is the most appropriate next step according to emergency response guidelines?