MRCPsych Emergency Response Procedures 3 — Questions and Answers
Question 1: A patient with known schizophrenia is brought to the emergency department by police under Section 136. Within what timeframe must a Mental Health Act assessment be completed?
- 6 hours
- 12 hours
- 24 hours (Correct answer)
- 72 hours
Correct answer: 24 hours
The Mental Health Act 2007 amendment requires a Section 136 assessment to be completed within 24 hours of arrival at a place of safety.
Question 2: In rapid tranquilization of an agitated patient, lorazepam is preferred over diazepam for intramuscular use primarily because:
- Lorazepam has a longer duration of action
- Lorazepam has more predictable intramuscular absorption (Correct answer)
- Lorazepam has no active metabolites and fewer drug interactions
- Lorazepam causes less respiratory depression
Correct answer: Lorazepam has more predictable intramuscular absorption
Lorazepam has more reliable and predictable absorption when given intramuscularly compared to diazepam, which has erratic IM absorption.
Question 3: A psychiatric patient in the emergency department develops acute dystonia after receiving haloperidol. What is the first-line treatment?
- Oral diazepam 10mg
- Intramuscular procyclidine 5-10mg (Correct answer)
- Intravenous haloperidol at a lower dose
- Oral propranolol 40mg
Correct answer: Intramuscular procyclidine 5-10mg
Intramuscular procyclidine (an anticholinergic) is the first-line treatment for acute dystonia caused by antipsychotics.
Question 4: When assessing suicide risk in an emergency setting, which validated tool is most commonly used to guide immediate clinical decision-making?
- PHQ-9
- Columbia Suicide Severity Rating Scale (C-SSRS) (Correct answer)
- HAM-D
- GAD-7
Correct answer: Columbia Suicide Severity Rating Scale (C-SSRS)
The Columbia Suicide Severity Rating Scale (C-SSRS) is widely used in emergency settings to assess suicide ideation and behavior severity.
Question 5: A patient is found unresponsive following a suspected benzodiazepine overdose. After ensuring airway, breathing, and circulation, which pharmacological agent may be administered?
- Naloxone
- Flumazenil (Correct answer)
- Physostigmine
- N-acetylcysteine
Correct answer: Flumazenil
Flumazenil is a benzodiazepine receptor antagonist used to reverse benzodiazepine-induced sedation in overdose situations.
Question 6: In managing a patient with acute alcohol withdrawal in a psychiatric emergency setting, which scale is most commonly used to guide benzodiazepine dosing?
- Brøset Violence Checklist
- Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) (Correct answer)
- Modified Early Warning Score (MEWS)
- Brief Psychiatric Rating Scale (BPRS)
Correct answer: Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar)
The CIWA-Ar scale assesses the severity of alcohol withdrawal and guides symptom-triggered benzodiazepine administration.
Question 7: A detained patient under Section 2 of the Mental Health Act refuses emergency medical treatment for a physical condition unrelated to their mental disorder. Which legal framework governs this situation?
- Section 2 of the Mental Health Act authorizes treatment for all conditions
- The Mental Capacity Act 2005, with an assessment of decision-making capacity (Correct answer)
- Section 63 of the Mental Health Act covers all treatments
- The patient must consent as physical treatment is not covered by the MHA
Correct answer: The Mental Capacity Act 2005, with an assessment of decision-making capacity
Detention under the MHA only authorizes treatment for the mental disorder; physical treatment refusal must be assessed under the Mental Capacity Act 2005.
MRCPsych Emergency Response Procedures 3
A patient with known schizophrenia is brought to the emergency department by police under Section 136.
Within what timeframe must a Mental Health Act assessment be completed?