2016 april Flashcards
After terrorist attack on an institution in Mardan a 22 years old student developed low mood, hyper-arousal, intrusive images in the day and dreams of event at night. When asked about the event, he cried and said “I don’t want to remember any part of it”. About the dead colleague he said “nobody died; they just can’t die”. At occasions he would laugh and say “nothing has happened, see I am so happy”
a) What is your diagnosis? b) What 3 defense mechanisms have been used? c) Write down its management according to NICE guideline
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a 17-year female, presented with one month history restlessness, lack of interest and poor sleep started after the father one month back. According to family hording is in her nature. Her mother also had similar prob On examination she is anxious, her mood is depressed repeated blasphemous thought and believes that she will as punishment.
a) What is your differential diagnosis?
b) What pharmacological intervention you will advice?
c) What is the prognosis of the case, justify your answer?
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Q.5 A young lady of 24 years presents to psychiatric OPD multiple after frequent arguments with family members, anger outburst self-inflicted injuries and then becomes tearful because of independent plans and asks her parents to forgive her as she cannot live them. Her academics and social functioning is badly affected.
a) What is the most likely diagnosis and differentials?
b) List the pharmacological and psychological therapies for describe psychological treatment of choice in detail.
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Q.6 A forty years old lady comes to your clinic with symptoms of low mood, fatigue, loss of appetite and insomnia for the past few w On examination she has loss of interest hopelessness, feelings of worthlessness and fleeting death-wish. She thinks that most of her difficulties are due to a psychiatric illness as she has seen her sister suffering from similar symptoms when she had her first child. You prescribe her antidepressants. She has following queries, how will you respond to them?
a) What is the chance of my daughter developing this disease, she is a 17 year old college student?
b) Will I become dependent on these drugs? Can I safely quit them?
c) What happens if I don’t take treatment?
d) If after taking the full course of treatment recover, will be immune to further such episodes?
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Q.7 A 5 years old boy has been brought to the Child Psychiatry Unit with the complaints that he is completely isolated, rarely plays with other children, is indifferent towards family members, prefers a specific toy. moves back and forth in a repetitive manner. He does not like being held. He sleeps and eats well-On examination he is of normal height and weight for his age and there is no physical abnormality. He avoids eye contact with the resident on duty and does not respond to questions or commands.
a) List four clinical conditions that you will consider in differential diagnosis
b) How would you manage this case?
c) If parents of this child ask you to give them information about next child having a risk of developing the same condition, how would you respond in 2 to 3 lines?
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- A 40-year male, married graduate officer at a security agency ole back was admitted at a chest unit, where he was diagnosed as interstitial lung disease and discharged with one month prescription of prednisolone, anti-diabetic, anti hypertensive and anti-lipid drugs. Two weeks back he started feeling high, became talkative, irritable, excessively shopping and at times his attitude become threatening with poor sleep. His wife told that his mother is bipolar, and has no past history of psychiatric illness or drugs. Chest-physician added alprazolam to his treatment psychiatrist.
a) Write three most appropriate differential diagnosis according to #ICD-10.
b) Write down management plan.
c) What is the prognosis and give reasons of your answer?
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The government has asked you to make a public mental health plan to incorporate mental health into public health sciences in your province Write down the salient features of your plan.
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A 35 years old married, female teacher presented with lack of interest in sexual activity for the last six months. She had a miscarriage six months back after that she developed depression. The depression improved on fluoxetine and she resumed her duties but she was advised by her family physician to continue treatment for another three months. Now her desire relations with her husband are strained because of her loss of sexual
a) What important factors you will consider in the history?
b) How will you manage this case?
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A 65-year male presented with one year history of forgetfulness, restlessness, weeping. difficulty in walking, urinary incontinence and disturbance of sleep. On examination he is wearing pampers, restless, apathetic, answer briefly in low tone, mood depressed, marked short term memory impairment, poor spatial orientation and has shuffling broad based gait. His vitals are normal, score on MMSE is 18, CT brain shows age related changes. He was seen by his family physician one month back who had advised him a combination of levo & carbidopa, aspirin, antihypertensives and gingko biloba.
a) Write three differential diagnosis of this case?
b) What investigation you will advise?
c) How you manage this case?
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Based on your knowledge of psychoneuroimmunology answer the following:
a) What immunological changes occur in Depressive Disorder?
b) What is the immunological link between increases coronary vessel disease with Depressive Disorder?
c) What are the medical conditions in which the possible immunological link with depression is under investigation?
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Based on your knowledge of genetics answer the following:
a) Define: (i) Heritability (ii) Penetrance (ii)Concordance
b) Name three disorders related to psychiatry which has highest heritability
c) What is 5.HT.Transporter gene polymorphism and it’s implications?
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Based on your knowledge of physical treatments in Psychiatry, and following: a) What are the neurochemical effects of Electro Convulsive Therapy b) What mortality risk is associated with Electro Convulsive Therapy c) What are the neuropsychiatric indications of Deep Brain Stimulation d) Name the stereotactic procedures used in psychosurgery.
ok
A 20-year male, single, matriculate, was alright one and half year back when he started smoking charas. One day without any apparent reason he started shouting, abusing and laughing . On examination he has auditory hallucinations and paranoid delusions against his friends and neighbours. His mother told that he had febrile fits during childhood and his uncle is schizophrenic. He was given risperidone in full dose and long acting injections for several months but never been asymptomatic. a) What is your differential diagnosis? b) What will be your pharmacological and non-pharmacological intervention? c) What will be the prognosis of this case and justify your answer?
Ok
Q2 A 36-year male hospitalized for 3 weeks back following his second hypomanic episode in a year. His mental state has settled satisfactorily on haloperidol. He has agreed to take lithium prophylactically. a) How do you prepare him for lithium therapy and how do you initiate and monitor treatment? b) What are the side effects of lithium at therapeutic levels and what are the clinical indications of lithium toxicity? c) What options are available as second line treatment if lithium therapy is unsuccessful in maintaining the patient?
Ok
Q.8 A 10 years old boy was brought to the pediatric psychiatry clinic.by tired-looking grandmother who has been raising him since his mo died 5 years back. The grandmother detailed a long history problems managing the child. He never liked school, did poorly had been frequently truant. Recently, he had robbed a younger boy in his school and threatened him to beat him up. School records show learning problems with poor reading capabilities. a) Most likely diagnosis would be? b) Give the diagnostic criteria of this disorder.
Ok
