2018 Sep Flashcards
A 40-year old patient of chronic schizophrenia is having clozapine 450mg per day and has 45% improvement in his symptoms but is unable to tolerate higher doses of clozapine.
a) What strategy would you opt in this case?
b) What are the options for refractory schizophrenia other than clozapine? Give dose ranges of anti-psychotics.
okay
A 28-year old female presents to the clinic, but the doctor is unable to fully carry out an assessment as the patient is mute and does not make any eye contact. According to the mother, the patient has been like this for the last few weeks and has hardly eaten anything. She has told her mother that she is like ‘dead’ and that she does not need to be fed. Earlier today, she is saying that it is better to die instead of living with life. Her past psychiatric history is unremarkable.
a) List five differential diagnoses.
b) Choose the most likely diagnosis.
c) How would you manage this patient?
there u go
A local social worker has referred a 28-year old air-hostess to you for assessment of her complaints of inability to cope, excessive fear, nightmares and avoidance to go her duty place following an emergency landing of her aeroplane, soon after one of engine of plane got major
problem 02 months back.
a) Enumerate the underlying neurobiological phenomena in this case.
b) Enumerate risk factors that predispose to that condition
c) Patient requested you to treat her with non-pharmacological intervention. Please enlist phases of EMDR protocol.
okay
A 63-year old man was found collapsed. A Department of Psychiatry outpatient Card was found in his jacket, together with a bottle of procyclidine tablets. He was febrile (38.2°C), conscious but unresponsive to commands. The blood pressure was 160/105 mmHg and there was marked muscle rigidity.
a) What is the most likely diagnosis?
b) What is the cause of his symptoms?
okay
A 30-year old gentleman is described as stubborn and obstinate by those around him. He lays great emphasis on order and discipline. He likes planning in advance to avoid any unexpected happenings. He is very careful with money and has a limited social circle. On the mental status examination, the patient does not reveal any abnormalities in mood thought processes or thought content.
a) What is the most likely diagnosis and differential?
b) Give the main features of this disorder.
okay
A 35-year old driver was referred to you because of decreased appetite loss of sleep and irritability of 03 months duration. There is no past family history of any psychiatric disorder. Being the only earning member his family he has to go on work daily. On examination his pulse is 90/m with an irregular rhythm.
a) Enumerate all possible differential diagnosis in this case?
b) Outline your assessment and management plan
c) What precautions you will take while prescribing psychotropic medication in this case?
okay
A 16-year old girl had gone to spend her summer vacations at uncle’s home to the other city. One day, about 15 days back, her uncle’s son showed her some pom videos and seduced her to have sexual relations with him. On refusal, she was abused sexually. When she returned home she had complaints of nightmares, jumping in bed on opening of the door, persistent dull lower abdominal pain, irrelevant talks, fearfulness and poor sleep
a) Enumerate 5 behavioral and emotional sequelae which can be expected in a sexually abused girl in childhood/adolescence?
b) Enlist differential diagnosis considering the above scenario?
c) Give non-pharmacological options to manage the late effects on an individual who has been subjected to sexual abuse and what is the aim of these non-pharmacological treatments?
okay
Parents have brought their 4-year 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 four clinical conditions that will be considered 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?
okay
In view of increasing needs for elderly population requiring psychiatric help your Medical Superintendent asks you to develop a senior citizens clinic
a) Enlist and classify all medicines that you will need. State the principle on which you base your choices.
b) Enlist 8 psychometric tests scales will be needed?
c) Which information do you think you will consider while developing an intake proforma?
okay
10 A 40-year old man getting treatment from a psychiatrist for paranoid schizophrenia is arrested for murder.
a) How will you assess whether he is fit to plead?
b) What are the essential parts of defense on the psychiatric ground?
okay
A 16-year old girl presents with multiple instances of unconsciousness. They started about six months ago and have become progressively worse. During the episodes, there is a jerky movement of the body but no urinary or fecal incontinence. These symptoms last for a few minutes and are followed by drowsiness. Neurological examination is normal.
a) What differential diagnoses would you consider in this case?
b) What other information would you acquire from the family about the episodes?
c) Which specific investigations would you like to order?
o
12 A young man of 27 years comes to you with a heavy folder containing numerous ultrasounds and lab reports of GIT related issues. All his reports are consistently negative but he has finally been referred to you by your medical colleague when he continues changing doctors. His complaints of Gl disturbance is not consistent with any such disease.
a) Enumerate the different terminologies used for such condition.
b) What are the predisposing and perpetuating factors in such case?
c) How do you go about convincing him?
o
.13 You have been asked by the local school to give a 45-minute talk to matric (class X) student about tobacco use. How will you organize your thoughts and what will you include in the talk?
o
14 A 27-year old female is a known case of Bipolar Affective Disorder and has been kept on lithium for the last 2 years. She has got pregnant 1 month back and has visited you as her psychiatrist.
a) Doctor, what is the risk of Lithium to my child if I continue with it?
b) What is the risk to me if I quit Lithium?
c) What are the alternate options if I don’t want to continue with Lithium?
o
A 35-year old patient suffering from mild Depressive Episode with Anxiety is enrolled for cognitive behavior therapy.
a) List the likely steps involved, and the number and duration of sessions required in this case,
b) Name four techniques that are to be used by the therapists in this patient
o
