2013 March Flashcards
A 20 year old single female presents with repeated hand-washing. Spending long hours in front of the mirror, trying to judge if her both eyes appear of the same size, and hurling abuses at anyone who interferes or stops her from doing so. She had about of prolonged fever a year ago, in which she had developed an altered state of consciousness for a week. She has multiple small swellings on her body and a brownish mark in the scapular region. She has a Body Mass Index of 16. a) Enumerate six clinical conditions that you would consider in the differential diagnosis in this case. b) Develop an algorithm of management that you will follow to treat her repeated washing rituals. c) Identify the International guidelines on which you have based your algorithm.
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A 35 year old patient is brought by his family for repeatedly making the following statements: “When try to think, my head fills up with noises, that is heard by everybody in the room” “My thoughts were taken from me, years ago by the Pesh Imam of my village’s mosque” “An alien agent has inserted a chip in my head. by making a hole in my skull to control my brain”, “People act as if they know what I am thinking”. Further inquiry reveals that he has thrice attempted to kill his wife, and of late has become totally house bound. He is wearing dark glasses while in the interview room. He is being treated for hypertension and hepatitis by quack. His physical examination reveals a pulse rate of 100 per minute, and his B.P is 100 60 mm of Hg. He is not sure about the date, and the month, and is unaware of his whereabouts, while he is sitting in the clinic. He has tremors of both hands, and is mildly jaundiced. a) Translate each of the four statements of the patient into phenomenological terms. b) List five most relevant questions that you will ask to assess his current violence risk c) list four conditions that you will consider in differential diagnosis
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A 28-year-old recently married female is brought to a psychiatric is mute and does not make any eye contact. According to her me patient has been like this for the last few weeks and has ha anything. She has told her mother that she is ‘dead’ and therefore be fed. Earlier on the same day, she was found digging garden as she wanted to bury her “dead body. Her past psychiatric history is unremarkable. a) List five differential diagnoses that you would consider in this ca justify your first choice. b) How would you manage this patient?to her routine hour
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A 25 year old lady, presented with 3 months history of sleep disturb decreased energy and multiple aches, and pains. Previously, she good home maker, but currently she finds it difficult to do her routine chores. Her mood remains low and irritable. She drinks excessive of water but feel thirsty. She has gained 6 kg of weight in the last weeks. Her pulse is 58/minute, blood pressure is 90/50 mm of Hg. Oeden of feet is evident, and she has bronchial.
a) What is the most likely diagnosis?
b) What general medical conditions would you rule out?
c) How would you manage this case?
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During an informal gathering, a teacher at a medical school discusses we you about a first year student, who has just moved away from parents to al hostel. The teacher states that he behaves strangely, and tries to avoid socialization. He does not have any friends but passes his time with video games. He sometimes enjoys spiritual activities and shows interest in magic. When a colleague tried to make fun of him, he resented a lot and lodged written complaint with the principal. The parents states that he is like this since his early life and has always been “different” but a “good”
child. His academic record varies from average to above average.
a) What is the most likely diagnosis?
b) What psychodynamic factors may have contributed to this condition
c) What are the risk factors for developing this disorder?
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A young female has been seen for the first time in Psychiatric OPD with symptoms of aggressiveness, abusiveness, irrelevant speech, decreased functionality, in congruent mood and a firm belief that her intestines are made of wood. She wears warm clothes in hot weather and exhibits profound psycho motor retardation. On general examination she is anemic, and obese. There is a history that she has been taking Olanzapine for 3 months, prescribed by some local GP. Her BMI is 32.
a) What is the most likely diagnosis of this case on multi axial system?
b) What specific investigations you will request. Identify the changes you expect in these tests?
c) Would you continue the present treatment or like to change it? Justify your choice.
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Parents have brought their four year old son with history of unusual interaction with others. He seldom plays with other children and prefer specific toy truck. He spends much of the morning with this toy, moving it back and forth in a repetitive pattern. He never interacts with other children and is indifferent toward family members. His mother describes him as “fussy baby” who did not like being held. His parents cannot remember him smiling as a baby or ever wanting to play peek-aboo, despite their efforts to engage him. He enjoys looking at pictures in his parents’ photo album and tends to return to the same pages again and again. His parents describe that he almost never initiates an activity or engages in reciprocal play. He sleeps and eats well. He was reportedly born out of a difficult labour with an Apgar score of 6/10. He started to develop febrile seizures soon after birth with kernicterus. On examination he was of normal height commands. and weight for his age and there was no physical abnormality. He avoids eye contact with the examiner and does not respond to questions or
a) List five clinical conditions that you will consider in differential diagnosis.
b) How would you manage this case?
c) What informational care would you provide to the parents as regards the child’s school performance and his long term prognosis?
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The National Assembly of Pakistan has recently passed a legislation use of corporal punishment in schools. You decided to undertake research on the correlation of physical abuse of students by the intes and their academic failures in exams
a) What hypothesis will you generate before starting the research?
b) What type of study design will it be? Justify.
c) Enumerate the variables that you would like to record. Give reasons
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A 75 year old lady was brought by her son and daughter in law with one year history of gradually increasing memory disturbances. For the last four weeks she has started blaming her daughter in law for not giving her and stealing her money. In spite of full care provided by her daughter in law and grandchildren, she complains about them, showing temper tantrums. At times she panics and says that she is about to die and is going mad”. She also says that her dead husband calls on her during the night. She is a known hypertensive and takes tab. atenolol 50mg/day Her CT brain shows atrophy of brain with white matter ischemia. Her “blood CP is normal cholesterol level is 233mg/dl. Her fasting blood sugar is 150mg/dl and her
a) What is the most likely diagnosis?
b) List the three differential diagnoses.
c) List three medications that can potentially improve her clinical profile
d) Identify four suggestions to her family regarding the psycho social care of the patient.
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HE70.10 You have been asked to provide forensic psychiatry support for prison services in your area. a) What specific areas of criminal evaluation would you offer keeping in mind the Mental Health Act 2001? b) What are the various human resources, psychometric, and treatment facilities that you would require to make the forensic evaluations?
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A 32 years old lady was referred by a social organization for the treatment of injection buprenorphine dependence. She was a victim of acid treated one year back at a general hospital where she received inject buprenorphine during trea ring treatment. She continued these injections and now uses about 10-20 injections I day. She also uses injection promethazine and tablet alprazolam in high doses. On examination she has several scars on her body due to old burns and abscess on her arms due to injections and her mood is depressed. Her TSH is 30 IU/L, ALT is 35 IU/L.
a) List the therapeutic challenges in this case
b) List the management steps that you will put in place for her that you will put in place for her
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A 19 years old male has been brought by police with history of behaving violently with a friend on a minor conflict. His parents later came and informed about similar episodes in the past, but that were always followed by guilt, remorse and reproach and staying sad for a few days there-after. The onset of aggression is sudden, unpredictable and duration is always brief. He is known to behave essentially normal in between such episodes and is able to fully recall the events related to the episodes. He is known to his sudden, unpredictable few days there-after.
a) What is the most likely diagnosis (use ICD-10 category)?
b) Which other categories can present only in episodes followed by regret
and remorse with complete preservation of memory related to the events?
c) What specific questions would you ask to confirm these types of disorders?
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A 31 year old female who’s house was invaded by dacoits one month ago presents with symptoms of memory lapses, numbness and going-blank. During these episodes she is unable to identify current events. She also complains of poor sleep and lack of appetite.
a) What is the list of differential diagnosis that you would consider?
b) List two non-pharmacological and two pharmacological interventions that may help this patient…Support your answer with current evidence/references.
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Your supervisor has persuaded you to conduct a genetic research on mental illness. What ethical considerations will you keeping in mind perspective the Declaration of Madrid?
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Mrs. X reports to her obstetrician on the 14 day of delivery. Her mother in law reports that Mrs. X is unable to sleep at night, and refuses to feed her offspring. When approached, she starts to shed tears. She fears that her breast milk is poisonous. You are asked by your obstetrician colleague to help them manage the patient a) What clinical conditions would you consider in differential b) Name specific lab and psychometric tests that you will request. Justify your choice c) What specific treatment options will you consider in this case d) Name two psychotropics that will be relatively safe for use if she decides to start to feed her child on breast milk.
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