2017 July Flashcards
A 34 years old male married for the last 4 years, has two children and a shopkeeper by profession. During history taking he reports, “My wife who is 21 years of age, is not loyal to me. She has a sexual relation with a teenage boy in the neighborhood. Whenever I make a phone call, her phone is busy. I have frequently found semen stains in undergarments of my wife. I believe I am not the father of my children. Whenever I come home my wife is well groomed. I keep her locked in the house for last three months. I frequently change the locks of the house a) What psychosocial areas would you like to explore in the history? b) How would you do the risk assessment in this case? c) What is your provisional diagnosis? d) What treatment options are available in this case?
O
You are asked to develop a special clinic for Bipolar Affective Disorder. a) Enumerate ten epidemiological findings (worldwide research-based) to justify for such a need? b) Enumerate 5 characteristics features of this disorder in children. c) What are the predictors of suicide in bipolar disorder?
O
A 15 years old boy who could not manage to save his 3 years old sister who has swept away in the flood. He has terrifying nightmares and gets up at night drenched in sweat. While awake he suddenly experiences images of his sister drowning and screaming for help. He even experiences the wetness all around him. He becomes extremely frightened by these experiences but he can’t stop them. He does not leave his tent because he feels sick at the smell of wet mud that the flood has left behind. He feels numb most of the time, it is as if he can’t feel very much at all about anything. He finds it difficult to respond or behave normally with the other people a) What are your two differential diagnoses? b) Elicit 4 symptoms by giving examples from the above scenario that lead to a specific diagnosis? c) What typical reactions are seen in this disorder in individuals between the age of 12 to 17 years? d) What components of Psychological First Aid can be applied in this scenario?
O
A female patient repeatedly reports in medical OPD with a chronic backache which has been fully investigated during the last one year and no organic pathology is found. She appears anxious and depressed but emphasizes on physical illness a) What can be most probable diagnosis according to ICD-10? b) What important differentials should be kept in c) How would you asses and treat such a patient
O
A 25 years old unemployed single male is brought by his family for recurrent suicidal threats, irritability, impulsivity, inappropriate anger, frequently feeling of affection, hate, and anger for both sexes. He also shows symptoms of depression and hypomania for last 6-7 days. He has been found roaming in the slums of the city and arriving home late at night. He tends to sleep late at night and wake up late at next day. He openly states “I feel empty and hollow from inside” a) What is your diagnosis according to ICD-10 and DSM-5? (Use appropriate codes). b) List four conditions that you would consider in the differential diagnosis. c) What are the major risks that you will keep in mind in the management of this case?
O
A 45 years old patient has the feeling of sadness for the last 10 years associated with lack of interest, irritability, poor concentration, disturbed sleep, and low appetite. Occasionally, he also has difficulty in recalling names of familiar persons. For the last few days, he has episodes of hyperactivity with agitation. He sometimes believes that his body organs are not working and his guts do not exist, so he refuses to eat. He believes that other people of his tribe are against him and they want to harm him. Mental state examination also reveals suicidal ideation. a) What is your provisional diagnosis using the appropriate ICD-10 code? b) Enlist any 3 differentials that you consider? c) How will you manage this case?
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You are asked to see a child admitted in the paediatric unit of your hospital. pediatrician tells you that the symptoms and patterns of this illness reported by mother are extremely unusual. There is a history of repeated hospitalization but no conclusive diagnosis or cause could be established His signs and symptoms improve when his mother is not around. a) What clinical indicators you would look for that might support your diagnosis? b) What is the most likely diagnosis? C) How would you manage this clinical scenario?
O
A 76 years old man was brought by his son and daughter with 2 years history of gradually increasing memory disturbances. For the last few weeks he is suspecting family members for stealing his things and not taking proper care of him. He has fallen twice last week He has developed tremors, is a known hypertensive. His CT brain shows atrophy of brain with white matter ischemia. He has chronic smoking history a) What is the most likely diagnosis? b) List 2 differential diagnosis. c) List 3 medicines that can potentially improve his cognitive impairment. d) If the attendants of this patient ask you about possible risks to this patient in daily life, respond by naming 5 possible risks
O
Parents have brought their 4 years old son with some strange observations about him. He rarely plays with other children, is indifferent toward family members, prefers a specific toy, moves it back and forth in a repetitive manner. He does not like being held, 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 examiner and does not respond to questions or commands a) List six 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?
O
A 30 years old prisoner is brought to the psychiatric hospital by the police from court with history of tearing of papers with Holy verses. He has been found on a street, unkempt, dirty wondering. He is talking irrelevant and not making rapport when interviewed. He is under trial for above offence. a) What factors will be considered to decide that this patient is competent to stand trial? b) Enumerate reasons for hospital transfer of prisoners with psychiatric disorders. c) What would be the salient features of the psychiatric options to be submitted to the court?
O
A 22 years old male patient presented to psychiatric OPD with episodes of altered taste in the mouth and perceiving a strange smell followed by jerky itsmovements with tongue bite and mouth frothing lasting for 1-2 minutes. Sometimes the patient goes completely blank, eyes becomes wide staring with dilated pupils and unresponsive to questions or commands for a period of 1-2 minutes. On the other occasions, the patient begins to dribble saliva followed by lip-smacking. The patient also suffers from episodes of increased heartbeat and fearful thoughts that he is about to die a) What is your diagnosis? b) What 5 other conditions you would like to rule out? c) Name any six medicines that are more effectively used these days to treat this condition.
O
An 18-year-old female was referred from the emergency department for psychiatric consultation, with the complaints of fever, altered level of consciousness, rigidity, and tachycardia. The attendants report that she had been using Haloperidol 5 mg, more than prescribed by the doctors. a) Name 3 other possible risk factors that could lead to this condition. b) Write down the provisional diagnosis and 3 differentials. c) What investigations would you advise? d) How would you manage this case?
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While celebrating World Narcotic Day, you have been asked to prepare an evidence-based talk for your juniors based on following questions: a) What is the ICD-10 criteria to diagnose substance use disorder? b) What are the early behavior changes which are observed in drug dependence? c) What are the mental & behavioural effects of Substance Use according to ICD-10?
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Enumerate five factors predicting a poorer response to lithium. b) What are the psychotherapeutic interventions recommended in bipolar disorder? c) What do you know about the course and prognosis of bipolar disorder?
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A newly married female known epileptic patient presented to your OPD with excessive concerns about the use of antiepileptics during pregnancy. She had been searching various websites for this. What facts/options you will consider in this case in relation to before, during and after pregnancy?
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