2018 March Flashcards
Q9 and 10 are missing
A 39 years old cleric, who runs a part-time carpenter shop, visits you after a year. He has a previous diagnosis of Generalised Anxiety Disorder and been exhibiting an old history of poor compliance. His work performance has decreased a lot in the past few months and he is having difficulty keeping the household. The thoughts of something bad about to happen have increased again and this has led to episodes of pounding heartbeat, shortness of breath, perspiration and withdrawal from his work. What are the most common reasons of non-compliance in patients on psychiatric medications? Enumerate any five What strategies could you use in such patients to improve compliance? Give three strategies, not exceeding three lines per strategy. c) Name two methods apart from medicines that can help him in his current problems with reasoning.
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A 35 years old female teacher presented at psychiatric OPD with two years history of depressed mood, decreased confidence and persistent low self-esteem. She never improved with treatment for more than few weeks during the course of illness. Write three differential diagnoses and justify the provisional diagnosis b) Enumerate the risk factors in this case c) Write down the treatment of this case
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A 25 years old female patient is referred by her GP to whom she reported with a backache. She complained bitterly about a female colleague who recently joined the same office 6 months ago where she had been working that her new colleague is getting too much attention in spite of that she was more competent, good looking and cooperative to everyone. She was demanding that her colleague should be fired from the job otherwise, she will commit suicide. On the interview, she appears vain and shallow, she was dressed provocatively and her emotional expression exaggerated. What is your preferred diagnosis? Enlist at least two differential diagnoses. Identify at least three problem areas in the management of this case. Enlist at-least three aims of your management? Name two defense mechanisms used in this disorder.
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A 40 years old male, married for the last 8 years, father of 5 children, shopkeeper by occupation says during the interview “My wife who is 26 years old is not loyal to me. She has illegal relations with a teenager boy who visits home in my absence and is her cousin in relation. Whenever I make a phone call from a shop, home phone is busy. I keep checking the evidence of illicit relationship repeatedly especially for semen st in under-wears of my wife. I believe these children are not mine. Whenever I come home she is well groomed with all sorts of cosmetics applied to face. I keep her locked in a room till return from my shop and keep on changing locks” While assessing this patient what areas will you ask during the interview? Categorize differential diagnosis according to DSM-5 What treatment options are available in this case?
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You are asked to see a 31 years old woman in a medical ward who has been an in-patient for 2 weeks undergoing investigations for constant pain in her upper abdomen for the last 2 months. This was initially thought to be gastric or duodenal in origin, but endoscopy was negative. Recently, it has been informed by her husband that she has presented to several hospitals over the past 2 years complaining wide variety of symptoms and different pains for which no physical cause had been identified despite multiple investigations. In addition, she is concerned about her physical symptoms but doesn’t consider them a warning sign of any serious underlying disease. After a detailed discussion about the case, the medical team has decided to get the psychiatric opinion
What is the most likely diagnosis and differential diagnosis in this case? What information in the history supports the most likely diagnosis? How will you manage this patient? What is Briquet’s syndrome?
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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 and 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. ASD a) List four clinical conditions that you will consider in the differential diagnosis. How would you manage this case? c) If parents of this child ask you to give them information about the next child having a risk of developing the same condition, how would you respond in 2 to 3 lines?
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A 19 years old female was raped (sexually abused in a parking lot by a stranger.) She was brought to the hospital by a police officer. She went through a number of medico-legal examinations and later, she was referred to psychiatry. During her psychiatric consultation, she appears to be traumatized, fearful, and weepy and she uttered only a few words during her interview.
Which psychiatric disorders she is prone to develop after this? Define universal interventions, selective interventions and indicated interventions in relation to psychiatric ailments. Enumerate two prevention programs to address physical and mental health risks in childhood and
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A 5 years old child is referred to you by a pediatrician, who has noticed poor eye contact. Parents are concerned that the child has poor verbal communication and shows episodes of aggressive behavior. Father works overseas and mother is a banker. Caretaker includes a 70-year-old grandmother and a part-time female maid. ASD What is the most likely diagnosis as per ICD-10 and name 3 additional conditions share with the same diagnostic category? What biopsychosocial investigations you will do to further assess the child? c) identify the main areas of speech and language difficulties in children that can serve as a checklist to refer such case for therapists.
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A 37 years old obese man whose elder brother had died due to heart attack, presented at ER twice in a week with pain on left side of chest radiating to the left arm. On both occasions, physical pathology was ruled out, including cardiac origin. He remained unsatisfied with treatment as his symptoms persisted. On his request Exercise tolerance test, Echocardiogram and thallium scan were performed which were found normal. He was referred for psychiatric assessment and treatment ) Write five psychological areas to which you will give special attention during the assessment of this case. Write three differential diagnoses. Write down five important points in the management of this case.
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A 55 years old female presents in psychiatric outpatient with few weeks history of altered behavior, crying spells and irrelevant speech. She is a known case of Parkinson’s disease for the last three years and had been stable on prescribed treatment. Enlist 3 possible sequelae with a potential risk factor for each one.
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Define the concept of Public Mental Health b) Identify at least five important areas in our society related to the prevention of mental illness. d) What you can do to decrease the stigma in psychiatry on an individual basis?
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A 32 years old male, single and educated up to matriculation, jobless and is staying with the family, has seven years history of schizophrenia. He is taking depot injections regularly, but still has negative features of schizophrenia and mild cognitive impairments. His family wants to know the treatment options other than pharmacological treatment. ay What are the various psychosocial treatment approaches you will explain to the family for this patient and their common goals? What psychosocial treatment interventions are of your choice for this patient and why?
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A 32 years old obese female, mother of 2 years old son presents with an episode of psychomotor excitation, elated mood and sleep disturbance for the last one week. Her detailed history confirmed the diagnosis of bipolar mood disorder for which she has been under treatment. Her last relapse was 3 years back when she was kept on lithium carbonate on which she remained well but stopped treatment on her own. Her labs revealed HbA1c 6.1 and serum TSH 6.2mU/L. What are the risk and benefits of restarting lithium therapy in this case? How will you minimize the adverse effect of lithium on this patient? For how long should the lithium treatment be continued?
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A 35 years old, male, single, school-van driver was caught molesting a child. On the request of his family, he was brought for psychiatric evaluation and treatment a How will you assess this person? Using the biopsychosocial model, what treatment option you can offer?
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A 21 years old woman, referred from gynecology ward for non-compliance of medical advice. She was admitted there for the investigation of irregular menstruation for the last three years. During hospitalization, she often refuses meals despite the insistence of attendants, but on other occasions, she takes out a lot of candies and chocolates from her bag and eats hurriedly. She was also found to have vomitings, but these seem to be self-induced, as witnessed by ward servant. Write three differential diagnoses. What biopsychosocial risk factors you will search during the assessment?
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