2012 october Flashcards
A family has brought their 72 year old patient of Alzheimer’s disease, who has now started to state that “They are all trying to snatch my property. He also says that “They shout at me and threaten me at night through cameras, and microphones placed in his room”. a) What important strategies will you explain to the son to deal with hallucinations and delusions in this case? b) What is the drug treatment? Write pros and cons of each group.
O
Mr. Nawazish is a worker in social welfare department. He has more than twenty years of service. He had certain problems due to which he has to be admitted in a psychiatric facility and later on he is found fit to resume his job. State the clause of mental health ordinance that deals with his expenses during his admission in hospital. Enlist important features of this clause of mental health ordinance 2001.
O
A 7 year old child is referred by a paediatrician after recognizing that the child is failing to thrive for no apparent organic cause. On detailed interview there were problems in parent.child relationship since early infancy. There is history of recent weight loss and reduced height. There is no problem with chewing and swallowing mechanisms. a) What is the diagnosis? b) How will you mange this child?
O
A 4 year old boy has just re-united with his biological mother after spending 6 months with in-laws and a difficult divorce. The boy is noted to play in destructive and disorganized manner, throwing and breaking his toys. He also hits and bites the mother if stopped. What is the most likely diagnosis and how will you manage this case?
O
A 25 year old lady presents with 3 weeks history of psychome overactivity. talking excessively and sexually disinhibited behavior was preceded by a history of depression started after the delivery of he first baby two months back for which she was treated with sertraline. a) What is the most likely diagnosis? b) How will you manage the case in light of recent guidelines
O
A 50 year old male presents with a gradual deterioration of low moon disturbed sleep and inability to cope. He has been treated with Paroxetin (upto 40 mg) for six weeks and later with imipramine (upto 200 mg/day) for eight weeks. His blood glucose is 7.8 mg/dl and he has a sustained reading of B.P (145/95 mmHg). a) What is the diagnosis of this case on multi-axial system of ICD-10? b) What investigations would you undertake? c) What will be the treatment plan in this case?
O
A 25 year old housewife presents with 15 days history of insomnia irritability, hypervigilance, nightmares, flashbacks and avoidance of activities. This started just after a dacoity at her home in which she and her husband was physically abused. a) What is the most likely diagnosis according to DSM-IV diagnostic criteria? b) What neuroendocrine changes may occur in case the state persists beyond six months? c) What evidence-based psychological interventions would you offer if the symptoms persist after six months? List the steps in the treatment in interventional strategy you will choose.
O
A 20 year old female who lost her mother in a car accident 3 weeks back, started feeling sadness less, easily becomes tearful restless with poor sleep and appetite. She feels mother’s grave. She often blamee her father as responsible for her eels very fearful when asked to sit in a car or go to the mother’s death. She mostly remains preoccupied in her thoughts and at times she sees her mother walking in the house. ath. She often ble when asked restless with no a) Identify the defence mechanisms that are being used in this scenano. b) What is the most likely psychosocial explanation of her state? c) What are the possible psychiatric disorders that you would consider in this case and why?
O
A 30 year old married housewife with 2 children is being treated for severe depressive episode for the last 3 months. She has shown little improvement with the trial of two anti-depressants, escitalopram and venlafaxine. a) How will you assess this case? b) What are the different steps and options for pharmacological treatment in this case? Please identify the international treatment guidelines that you have followed in your response.
O
A 26 year old film artist was referred to you by plastic surgeon because he is insisting for nasal surgery which the surgeon considers unnecessary? During initial interview the artist appeared low and weepy. He informs you that his nose was ugly and a reason for this recent failure in the film industry. He was upset on being referred to you for a physical problem
a) How will you assess the artist? b) List the differential diagnosis that you will consider. c) Outline your management plan.
O
A 35 year old teacher was referred to you because of low mood, weeping spells and difficulty in teaching of 06 months duration. During interview he exhibited psychomotor retardation. Examination revealed rigidity which was more marked on the right side of body. He has alread received some psychotropic medication from the local GP. There is no past history of any significant medical or psychiatric illness. a) What will be your differentialdiagnosis in this case? b) How will you investigate this case? c) Outline your management plan
O
A middle-aged male is referred to psychiatric intern for evaluation of deterioration in performance at work and mild stiffness of upper limbs. On LFT his alkaline phosphatase was found to be raised. Family was worried and reluctant to se admitted in psychiatric ward, as they repeatedly said ‘we have already lost one of his cousin with same problem; and now don’t want to lose him”. a) What is the most likely diagnosis in this case? b) What specific tests would you request for to confirm your provisional diagnosis? c) What treatment option would you offer to the family?
O
What is prodromal state of schizophrenia? What are the main findings of recent literature on the subject of predictive validity of prodromal criteria in predicting the development of schizophrenia in high risk population?
O
What is genetic counselling? What are the components of genetic counselling process? c) You have been asked to speak to a patient with bipolar affective disorder on the risk of developing a mood disorder in his offsprings. What factual information would form the basis of your approach?
Oo
19 year old young girl is brought by her mother with history of lack of interest and avoidence of food, weight loss of 18 kg (during last three months), fear of gaining weight, disturbed sleep menstrual irregularities and irritability. On examination blood pressure is 90/60 mmHg, pulse is 56/min, with physical emaciation. Neuropsychiatric evaluation reveals mild cognitive impairment. a) Give your differential diagnosis for this case? b) What further investigation would you carry out giving justification? c) How would you manage this patient?
O
