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Best of Five MCQs for the Acute Medicine SCE$
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Nigel Lane, Louise Powter, and Sam Patel

Print publication date: 2016

Print ISBN-13: 9780199680269

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780199680269.001.0001

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(p.403) Chapter 16 Psychiatry
Best of Five MCQs for the Acute Medicine SCE
Nigel Lane, Louise Powter, Sam Patel
Oxford University Press

A 29-year-old woman on an orthopaedic ward complained of pain following surgery to repair a complex fracture of her right ankle. She was given tramadol and within an hour she became sweaty and agitated. She had a past medical history of bulimia nervosa and was taking fluoxetine 60 mg daily, mirtazepine 30 mg at night, and diazepam 5 mg three times daily as required.

On examination, her temperature was 38.2°C, her pulse was 102 beats per minute and regular, and her blood pressure was 164/92 mmHg. Neurological examination revealed mydriasis, tremor, hyperreflexia, and increased tone in all limbs but greatest in the lower extremities and clonus induced by rapid dorsiflexion of the left ankle. Additional examination findings included normal skin colour and hyperactive bowel sounds.

Keywords:   advanced decisions, bipolar disorder, capacity, delirium tremens, fluctuating capacity, hearing voices, khat psychosis, lacking capacity, malignant hyperthermia, panic attacks

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