2012 march Flashcards
A 5 years old child presents with behavioral problems at home, that include refusal to follow parental instruction and poor table manners table manners. His teacher reports that he has difficulty in getting along with friends and day-dreams excessively a) What is the differential diagnosis? b) What will be the evaluation and management steps in this case ?
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A 3 years old child is referred by the paediatrician to you for evaluation Parents who are going through divorce after 4 years of unhappy marriage note that the child likes to stay by himself. Caregiver (Ayah) is able communicate with the child, though his language is delayed (can speak only one or two words) and plays with only one toy, although he has many toys a) How will you evaluate this child? b) What is the most likely diagnosis and the list of differential diagnoses? c) How will you manage this case? d) What is the short and long term prognosis in this case?
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A 60 years old banker is brought by his colleagues for making repeated mathematical errors in calculations, ignoring the entries of important financial documents, coming late to the office and frequently spilling tea on his clothes. a) What will be your provisional diagnosis and differential diagnosis? b) What specific physical and neurological and mental state signs would you look for? c) Name four laboratory and three radiological investigations you would consider while investigating this case?
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A relative of the patient who admitted the patient with the diagnosis of paranoid schizophrenia wants to take him home over the weekend. The patient is on maintenance dose of a) Give the leave procedure in accordance with the Mental Health Ordinance 2001 b) The relative does not bring the patient from leave on the agreed upon date, how would you proceed according to the Mental Health Ordinance 2001?
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A 56 year old man is getting medication for diabetes mellitus, ischemic heart disease and hypertension. He is currently admitted in intensive care unit by a medical specialist on account of chronic renal failure. The nurse on duty tells the doctor that the old man gets irritable, talks irrelevantly, does not recognize anybody around and fears his caregivers and family members. These symptoms usually become worse at night. a) What is the most likely diagnosis in this case? b) What are the major causes of such a presentation? c) How will you manage this case?
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A 52 years old lady is referred by a general physician with the complaint of abnormal movements around the mouth and some abnormal hand movements. The patient was treated by a psychiatrist 02 years back but never revisited the psychiatrist and continued the treatment on her own a) What differential diagnosis would you consider? b) What treatment options are available? During a TV interview it was stated that patients of schizophrenia are more likely to be violent than the general population. How would you respond inform the general population and compare it with patients with other mental illnesses focusing on the predictors of violence?
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A 35 year old male patient, suffering from bipolar affective disorder, is on lithium carbonate for last 10 years. He was stable till 6 months ago but since then has increased frequency and severity of episodes despite good compliance and consistent maintenance of lithium blood levels.
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What do you think may be the mechanism for this unresponsiveness to lithium? b) How would you manage this unresponsiveness to lithium? c) Lithium is relatively less effective, with an efficacy rate of around 30 per cent in which six conditions?
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A recent trial on effectiveness of typical versus atypical antipsychotics included that there is no difference in of the two groups Critically evaluate this statement in the light of recent advances naming #few studies with similar results and findings.
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A young lady of 28, came to psychiatric OPD with irresistible urge to over at followed by feelings of guilt and self induced vomiting. She also uses laxatives to compensate for overeating. She wants to know if this is a normal pattern of behavior or an illness? a) How you will respond to her? b) What do you think is the most likely diagnosis? Outline management steps for this patient according to NICE 2004 stepped care approach
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A chain smoker for the last 25 years, has recently been diagnosed with severe ischemic heart disease. His physician advises him to quit smoking but he is convinced that smoking has nothing to do with his health. His wife believes that he is dependent on cigarettes and it is difficult for him to quit. Respond to the following queries made by her a) What are the psycho physiological effects of nicotine? b) How would you mange nicotine dependence in this case? c) Is this a psychiatric disorder? If yes, what is it called in ICD-10 and what are the diagnostic guidelines?
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A 20 year old male from Waziristan, is brought to the Psychiatric Intensive Care Unit, for an urgent psychiatric consu arrest by agencies, after he attempted to blow himself with a bomb and made a physical assault on a quad at a check post. He continues to remain abusive and threatens to kill all “enemies of Islam , starts to wear when approached and thinks that he will blow himself up with a bomb to attain access to ‘heaven and other bounties” promised to him by his teachers a) Keeping in mind the risk factors for violent and suicidal behavior and the socio-cultural context of the individual, list ten questions that you will ask from the individual and the representatives of agencies to establish the abnormality/psychiatric disorder in the individual. b) If the individual does not fulfill any criteria of a formal mental illness how would you respond to a query by a media representative asking if the individual is mentally ill and “insane”?
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Mrs X, is a 26 year old known patient of bipolar affective disorder type 1 She is being treated with Valproic Acid and lithium carbonate. She now plans to conceive. She seeks your advice on the relative advantages and disadvantages of conceiving and using lithium during pregnancy. How would you respond to the following queries of the patient? a) What are the possible risks if I stop all treatment during pregnancy? What advise will you give? illustrate your response with references from literature? b) What risks do I run if I continue to use lithium during pregnancy? c) What impact can lithium have if I will breastfeed my baby?
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A 34 year old operating room assistant has been referred to you by physician to whom he reported 9th time in last three months with a fear that i he has developed AIDS, requesting to examine him and re-testing him for AIDS. He reveals that his room mate in the mess recently revealed himself to have homosexual relationships with multiple partners. The client himself never had a homosexual contact nor carries a factor for AIDS. He has anancastic-traits. He remains worried about his health however has no depression or disturbed biological functions. cal functions n fo a) What will be the differential diagnosis in this case? What is the most likely diagnosis? Justify. b) How would you manage this case?
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A 24 year old single male is brought by his parents for showing violent and abusive behavior, self muttering, inappropriate social behavior breaking into laughter one minute and then crying incessantly for no obvious reason. He is often seen gazing meaninglessly at objects and at times standing on one leg for an entire day. He has been ill for more than three years continuously. He has been treated with haloperidol, olanzapine and risperidone without any response to treatment. He has rapidly gained weight in the last few months and now weighs 110 kg. His height is 170 cm a) What could be the most likely diagnosis? b) What could be the reasons of the poor response to treatment? c) What is the likely pathophysiological basis of his rapid gain in weight d) What will be the individual’s BMI? What lab tests would you request for in this case? e) In the light of current evidence, suggest therapeutic options that you may consider
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