The most common psychiatric presentation seen in those with cancer is
A. Personality disorder
B. Psychosis
C. Mania
D. Depression
E. Alcohol misuse
⸻
✅ Correct answer:
👉 D. Depression
⸻
🔍 Explanation
• Cancer → major psychological stressor
👉 Most common psychiatric presentation:
➡️ Depression
• Especially in:
• Advanced disease
• Poor prognosis
• High symptom burden
⸻
❌ Why others are wrong:
• Personality disorder → not related
• Psychosis → rare, usually organic (e.g. meds, metastases)
• Mania → uncommon
• Alcohol misuse → may occur but not most common
Mrs. Y is treated for breast cancer with Tamoxifen. She is clinically depressed. Which of the following drugs is contraindicated in her situation?
A. Amitriptyline
B. Mirtazapine
C. Fluoxetine
D. Reboxetine
E. Venlafaxine
⸻
✅ Correct answer:
👉 C. Fluoxetine
⸻
🔍 Explanation
• Tamoxifen is a prodrug
👉 Needs CYP2D6 to convert → active endoxifen
• Fluoxetine = strong CYP2D6 inhibitor
👉 ↓ Tamoxifen activation → ↓ efficacy → ↑ cancer risk
⸻
❌ Why others are wrong:
• Amitriptyline → moderate effect
• Mirtazapine → safe
• Reboxetine → minimal CYP2D6 effect
• Venlafaxine → weak inhibitor → often preferred
⸻
💥 High-yield Paper B facts
• ❌ Avoid:
👉 Fluoxetine
👉 Paroxetine
👉 Bupropion
👉 Duloxetine
• ✅ Safer:
👉 Venlafaxine
👉 Mirtazapine
👉 Sertraline (moderate)
⸻
🎯 Exam takeaway
👉 Tamoxifen + depression → avoid CYP2D6 inhibitors (Fluoxetine)
You are talking to a nurse from the falls clinic. She wants to know the antipsychotic drug, which is least likely to cause orthostatic hypotension. Which of the following would you recommend?
A. Quetiapine
B. Amisulpride
C. Risperidone
D. Aripiprazole
E. Olanzapine
⸻
✅ Correct answer:
👉 B. Amisulpride
⸻
🔍 Explanation
• Orthostatic hypotension = α1 blockade
• Amisulpride:
👉 Minimal α1 activity
👉 → minimal postural hypotension
⸻
❌ Why others are wrong:
• Quetiapine → strong α1 blockade → hypotension
• Risperidone → moderate α1
• Olanzapine → some α1 effect
• Aripiprazole → low risk BUT not as “clean” as amisulpride in exam logic
⸻
💥 High-yield Paper B facts
• High hypotension risk:
👉 Quetiapine
👉 Clozapine
👉 Low-potency typicals
• Low hypotension:
👉 Amisulpride
👉 Aripiprazole
Rosy is a 20-year-old female who is concerned about her weight loss, diarrhoea and infrequent menstrual periods. She refuses to put the central heating on in her flat because it makes her sweat a lot. Her father thinks she is trying to keep the nagging mother away. Her parents are described as ‘domineering.’ What is her diagnosis?
A. Hyperthyroidism
B. Addison’s disease
C. Anorexia nervosa
D. Bulimia nervosa
E. Depression
⸻
✅ Correct answer:
👉 A. Hyperthyroidism
⸻
🔍 Explanation
This is a classic exam trap → looks like eating disorder but isn’t.
Key clues:
• Weight loss ✅
• Diarrhoea ✅
• Heat intolerance (“heating makes her sweat”) ✅
• Oligomenorrhoea ✅
👉 All scream hyperthyroidism
⸻
❌ Why others are wrong:
• Anorexia nervosa
❌ No fear of weight gain mentioned
❌ No body image distortion
• Bulimia
❌ No binge/purge
• Addison’s
❌ Would have hypotension, hyperpigmentation
• Depression
❌ Doesn’t explain diarrhoea + heat intolerance
⸻
💥 High-yield Paper B facts
• Hyperthyroidism can mimic:
👉 Anxiety
👉 Eating disorder
👉 Mania
• Key differentiator:
👉 Autonomic symptoms
(sweating, diarrhoea, tachycardia)
• Menstrual changes:
👉 Oligomenorrhoea common
⸻
🎯 Exam takeaway
👉 Weight loss + diarrhoea + heat intolerance → THINK THYROID
