2017 January Flashcards
papers
A 24 years old single male is brought to you by his parents for showing violent and abusive behaviour, self muttering, inappropriate social behaviour, breaking into laughter one minute and then crying incessantly for no obvious reason. He is often seen gazing meaninglessly at objects and at time times standing on one leg 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 last few months and weighs 110kg. His height is 170cm.
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 pathophysiology basis of his rapid gain in weight?
d) What will be the individual’s BMI?
e) What lab tests would you request for in this case?
f) In the light of current evidence, suggest therapeutic options that you may consider in this case. Justify your answer with at least one reference
aha
A 45 years old lady is a known case of psychiatric illness for last 15 years. Her illness consists of episodes of fatigue, listlessness, increased sleep and appetite interspersed with episodes of overactivity, talkativeness wearing flashing dresses and singing. She has been stable on medication
for the last 1 year but is complaining of weight gain, tiredness and lethargy for the past 4 months. Her BP is 140/90 and her pulse is 56 per minute. Her mood is euthymic.
a) What is the most likely diagnosis?
b) What complication of treatment has occurred?
c) What pre-treatment tests are recommended to prevent this complication?
d) How will you manage this complication?
e) What treatments would you recommended to prevent relapses in future in this case?
exactly
Mr. Waseem is a known case of depressive illness for the last 1 year. He has stopped responding after two different groups of antidepressants were tried and has been labeled as a patient of treatment resistant depression.
a) How will you assess the cause of this resistance?
b) Write down the treatment algorithm that you will follow for Mr. Waseem.
c) If you had to start Lithium in this case, what protocol would you follow to start it and how will you monitor it?
cheese burger
After an earthquake, a 22 years old college student developed low mood, arousal and intrusive imagery of the event in the day and dreams of the event at night. When asked to describe the event, he cried “I don’t want to remember any part of the event”. About the dead siblings he said “I know
they are still alive, 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? How will differentiate it from grief reaction?
b) What 3 defence mechanisms have been used?
c) Write down its management according to NICE 2005?
yes
A 30 years man is brought to psychiatric emergency. He is restless and agitated and gets easily excited. His pulse is 100/mm, his BP is 170/95 mmHg and he is profusely sweating. He is shaky and has difficulty giving his history. He has been sleeping for the last 30 hours. He sees spiders walking on the walls. His lips and tongue are dry and he has tremors in both hands. He has nail marks on his cheek which he states are from frequent fights with his wife. His tongue shows a bite mark and a recent bleed.
a) What is the most likely diagnosis?
b) Name three psychometric scales and three lab tests that can help you in diagnosis and assessment of the severity of his state.
c) Mention five psychosocial consequences if this condition is left untreated?
i guess
A 27 years old female patient has been referred from a skin specialist presenting with skin lesions of hands due to repetitive washing. Her mental state reveals intruding thoughts of dirt, taking more time in bathing dressing and praying, holding the opinion that she is never neat enough to do all the compulsory religious or home tasks. She feels that these acts are perfectly in order as it is her religious duty to stay “neat, clean and ‘PAAK. She terms all efforts to help her overcome this problem as “Satanic” she recall, developing headache and a high grade fever about a year ago
which lasted for a month.
a) What is the likely diagnosis and 3 differential diagnoses that you will considered
b) Mention the pharmacological options available to treat your provisional diagnosis.
e) Mention 2 psychological treatments that can help her.
d) Enlist 2 physical treatments that may be considered if all other steps fail
so shall we begin ?
Parents have brought their 8 years old child with 2 years history of mischievous behaviour, telling lies, stealing household items, fighting with other kids, anger outbursts and killing animals.
a) What is the most likely diagnosis?
b) What environmental factors could have caused this condition, enlist any three.
c) How would you manage this case?
d) Identify 2 bad prognostic factors each in the patient and the family
yes, family first
You have completed a work-up of a 72 years old male. He has been diagnosed to have Alzheimer’s disease of moderate severity. You have asked the patient’s wife and daughter, the two main carers to discuss the matter in more detail. In the light of current evidence and clinical guidelines give your critical remarks on the effectiveness of the following aspects
a) Psycho-educational interventions should be offered to help patient’s wife and daughter in this session. b) Enrolling the mother and daughter in a programme on Training of Carers’ being organised by an NGO. c) Use of CBT to relieve the distress of wife and daughter of the patient. d) Use of SSRI in treating depressive symptoms in patient’s daughter after she finds out about her father’s diagnosis.
A
Q.10 A 28 years old agitated man is brought to your hospital by his family with a rope. On examination he has paranoid delusions agains family members. He refuses admission. a) Which sections of the Mental Health Act 2001 are likely to come into play in this case? b) In your opinion which of these sections of Mental Health Act has the maximum potential for abuse by a health professional Justify.
A
A 30 years old lady presents in her eighteenth week of pregnancy with weeping spells, low mood which is worse in the mornings. She says “I get an urge to hit my tummy with an iron rod but I don’t do it, because I might hurt the foetus. I know it is stupid to hit one’s own self”. She cannot resist eating tissue papers, nutmeg and dry mud, but tends to vomit them after few minutes. She sleeps easily but wakes up early morning with an inability to go back to sleep. She also complains of deformed nails, easy fatigability and getting breathless after walking for twenty-five yards. a) What is the most likely psychiatric and medical diagnosis? b) Name three psychiatric disorders that you would consider in the differential diagnosis. c) In the light of an internationally accepted management guideline, what interventions would you prescribe for the most likely psychiatric and medical diagnosis in this case?
A
A 30 years old university lecturer presents to psychiatric OPD with the complaints of feeling of restlessness, heat intolerance, loose motions, fatigue, anxiety and profuse sweating. His mood is mostly irritable. He has lost 5 kg in the last 6 weeks. Occasionally his heart beats fast and he begins to fear as if he is about to die. On examination patient is found to have tremors and ankle swelling. a) What is the most likely diagnosis? b) What 2 psychiatric conditions would you rule out? c) List physical investigations of this case. d) How would you manage this condition according to bio-psychosocial model?
A
You have been asked to speak to the media on this year’s World Mental Health Day 2016 Keeping in mind this year’s theme, how would you respond to the following queries made by the media: a) What was the theme of world Mental Health Day 2016? b) What is the specific relevance of this theme in Pakistan’s context? c) What are the key principles of this mental health approach? d) Based on current research evidence on the subject, what is the consensus on the therapeutic efficacy of this approach?
A
A 26 years old pharmacist is a known patient of bipolar affective disorder. He has had three relapses in five years while on valproic acid. He seeks your opinion on switching to lithium carbonate and seeks any other intervention that can help him improve his adjustment in life. a) Which psychosocial interventions would you recommend to this patient? b) Which factors in this case would you look for that could prompt a positive response to lithium prophylaxis?
A
In around 500 words write a critical review supported by evidence on following theme: Comparison of the therapeutic efficacy and side effect profiles of typical and atypical anti-psychotics and the list of likely antipsychotics being made available in future.
A
16 An 18 years old young man has been brought to a psychiatric clinic with complaints of feeling excessively sleepy in the day and taking multiple short naps which are for few minutes. At times he suddenly loses balance due to buckling of knees while laughing excessively. He has also had such episodes in times of anger. At one time he dozed off while driving his father’s car. a) What is the most likely diagnosis? b) What other features will you look for to establish your provisional diagnosis? c) What specific features in history will help you in assessment? d) Name two neuro physiological tests that can help you establish the diagnosis. e) Name five drugs that can help this patient.
A
