Psychiatry - Patient examining Flashcards
PSY - 2.2
Misbehaviour(s) of doctors is/are:
1) identification instead of empathy
2) projection of their personal feelings onto the patient, establishment of an emotional relationship - with its ethical and legal consequences
3) treatment of the patient as an impersonal medical case because of the lack of empathy
4) balancing between confidentiality and objectivity
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
ANSWER
A) only the 1st, 2nd and 3rd answers are correct
EXPLANATION
The right medical behaviour is based on the equilibrium of confidentiality and professionalism, while the impersonalization or identification with the patient is faulty. Doctors should not get involved with patients in emotional relationships; in addition this has legal and ethical consequences.
PSY - 2.3
A psychiatric symptom might be:
A) a subjective experience or change of experiences – especially the suffering
B) a somatic symptom of disorder of function
C) too frequent or inadequate behaviour or the lack of it
D) combinations of the above
ANSWER
D) combinations of the above
EXPLANATION
psychiatric symptoms might manifest in the form of subjective experience changes, somatic symptoms or dysfunctions, excessive behaviour, lack of reactions or inadequate behaviour
PSY - 2.4
Building an effective doctor-patient relationship:
1) the first meeting has a prominent role
2) it is an essential condition that the doctor spends only the time necessary - equal to that spent with already known patients on control visits - with the first meeting with new patients
3) attention, honest, interest and the feeling of understanding are exceptionally important in creating trust
4) the office and clothing of the doctor should emphasize the professional superiority
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
ANSWER
B) only the 1st and 3rd answers are correct
EXPLANATION
the first meeting has a prominent role, plenty of time should be spent with the first visit, attention, honest interest and the feeling of understanding are exceptionally important in creating trust, while emphasizing the asymmetry might alienate the patient
PSY - 2.7
Some technical elements of the psychiatric clinical interview are:
1) comments instead of questions
2) paraphrasing the last sentence
3) short summarization for better understanding and to create the feeling of being understood
4) positive and hopeful atmosphere - like at any doctor-patient meeting
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
ANSWER
E) all of the answers are correct
EXPLANATION
Technical elements of the psychiatric interview for steering the conversation are (amongst others) paraphrasing the last sentences, comments instead of questions and short summarizations. Giving hope and creating a positive atmosphere is essential in doctor-patient interactions.
PSY - 2.8
Agitation means excessive motor or verbal activity, which manifests in:
1) hyperactivity
2) exaggerated expression of suffering
3) yelling, screaming and verbal abuses
4) provocation, threatening gestures and physical destruction
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
ANSWER
E) all of the answers are correct
EXPLANATION
hyperactivity is a basic sign of agitation and it often comes with the exaggerated expression of suffering, yelling, screaming, verbal abuses, provocation, threatening gestures or physical destruction.
PSY - 2.9
Priority interventions during the emergency service of agitated patients include:
1) empathetic, non-oppositional, calm but confident and consequent verbal intervention
2) demonstration of power
3) patient and consequent helping attitude, offering food, drink and other forms of help
4) voluntary and/or emergency medical treatment
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
ANSWER
E) all of the answers are correct
EXPLANATION
During the emergency service of agitated patients it is advisable to implement empathetic, non-oppositional, calm but confident and consequent verbal intervention. It is often useful to offer help in the form of food, drink or other aids and to conduct simple examinations. The calm, patient, understanding, confident and consequent verbal intervention is a key factor in such situations. In the case of extreme agitation the demonstration of power by summoning the available staff in itself prevents the escalation of the situation. Emergency medication might be necessary, but it is easier if the patient accepts one of the offered options.
PSY - 2.10
In the treatment of acute agitation:
1) the aim is to control the aggressive behaviour and to preserve the good doctor-patient relationship
2) the first step is the psychosocial intervention (empathetic, non-oppositional, calm but confident, consequent and helpful)
3) the second step is the (orientational) physical and psychiatric differential-diagnosis (whether the cause is somatic, intoxication or primary mental disorder)
4) the third step is the parenteral/oral therapy (possibly in the form preferred by the patient)
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
ANSWER
E) all of the answers are correct
EXPLANATION
the aim is to control the aggressive behaviour in short term and to preserve the good doctor-patient relationship in long term. The first step and a key factor is the right psychosocial intervention; the lack of it leads usually to escalated aggression. The right verbal intervention is empathetic, non-oppositional, calm but confident, consequent and helpful. Meanwhile the cause should be assessed, whether the agitation is caused by a somatic condition, intoxication or primary mental disorder. This is followed by the appropriate the parenteral or oral therapy possibly in the form preferred by the patient.
PSY - 2.12
Differential diagnosis of aphasias:
1) Individuals with expressive aphasia are able to understand speech, but they have disordered speech (with great effort they might produce fragmented speech)
2) In receptive aphasia the disordered understanding of speech dominates (the person does not understand his own or other’s speech)
3) In conduction aphasia spontaneous speech is intact, but the patient is unable to repeat sentences.
4) Transcortical aphasia disables spontaneous speech, but they have an urge to repeat speech (echolalia)
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
ANSWER
E) all of the answers are correct
EXPLANATION
Individuals with expressive aphasia are able to understand speech, but they have disordered speech because of the motoric disorder. In receptive aphasia the disordered understanding of speech dominates. In conduction aphasia spontaneous speech is intact, but the patient is unable to repeat sentences. Transcortical aphasia disables spontaneous speech, but they have echolalia.
PSY - 2.13
A 39-year-old male patient complains about diffuse anxiety, disordered attention and thinking. He perceives his environment to be alien. Sometimes he has strange thoughts against which he has to fight. He feels as if everything changed around him. Hearing all this, what would you do first?
A) immediately assign him to a psychiatric ward or outpatient unit
B) comfort him that he is not crazy
C) gather information about his present situation in order to identify what intervention is needed
D) ask about his childhood
E) prescribe anxiolitics and put him on sick-leave
ANSWER
C) gather information about his present situation in order to identify what intervention is needed
EXPLANATION
The listed symptoms (anxiety, decreased concentration, depersonalization, derealisation, pathological thought contents) might indicate a psychotic episode, which makes detailed examination necessary
PSY - 2.14
A 27-year-old female is referred to the outpatient unit with breathing difficulty, dizziness and numb limbs without any organic reasons. What do you think her diagnosis is?
A) situative reaction
B) endogenous anxiety
C) caffeine intoxication
D) hyperventilation syndrome
E) posttraumatic stress disorder
ANSWER
D) hyperventilation syndrome
EXPLANATION
Shortness of breath with dizziness and numb limbs indicates hyperventilation syndrome.
PSY - 2.15
Alcohol intoxication:
1) is a poisoning and has to be treated like other cases of poisoning
2) might cause several somatic syndromes, therefore it is potentially life-threatening
3) measuring blood alcohol concentration is an objective indicator in defining the intensity of treatment
4) addictology is part of psychiatry and it deals with the treatment of psychoactive substance dependencies and abuses involving sober patients, who accept and cooperate with the proposed treatment
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
ANSWER
E) all of the answers are correct
EXPLANATION
Alcohol intoxication is a poisoning, it might cause several somatic syndromes, and therefore it is potentially life-threatening and has to be treated like other cases of poisoning. Detoxication is not the competency of addictology, because this profession is engaged in the voluntary treatment of sober patients with psychoactive substance dependence or abuse.
PSY - 2.16
EEG spectrum:
1) delta band is of 0.5-3.5 Hz, it is predominant in deep sleep, it is physiological until the age of 1-2 years, it might indicate frontal hypoactivity in adults in wake states
2) alpha band of 8-12 Hz, this is the baseline rhythm in adults, it correlates with the temporal coordination of information processing, it signals the activity of thalamo-cortical circuitry and it is inhibited stimuli are present
3) theta band is of 4.0-7.5 Hz, it is predominant in REM sleep, it is physiological at the ages of 1-6 years, it can occur during hypnosis and meditation, it indicates frontal and hippocampal hyperactivation in a wake state
4) gamma band is above 35 Hz and it indicates neuronal synchronization, it can also be connected to the framing of information elements and consciousness functions, therefore this band is important in understanding the neuropsychiatric disorders
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
ANSWER
E) all of the answers are correct
PSY - 2.18
Brain imaging methods:
1) SPECT and PET are transmission methods, they use external ray
2) MRS and MRI are based on magnetic resonance
3) CT is a particle emission method
4) SPECT and PET use isotopes bound to active signal molecules
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
ANSWER
C) only the 2nd and 4th answers are correct
EXPLANATION
SPECT and PET are emission methods and the isotopes are bound to active signal molecules, CT is a transmission method, MRS and MRI are based on magnetic resonance
PSY - 2.20
The most common applications of PET are:
1) examination of brain metabolisms
2) blood flow measurement
3) examination of enzyme activity and concentration
4) marking neurotransmitters and receptors
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correc
ANSWER
E) all of the answers are correct
PSY - 2.21
Which is/are true for MRI?
1) white and gray matter are well distinguishable
2) a high-frequency radio transmitter allocates energy into the nuclei of the body placed into the static magnetic field
3) the radiation coming from the relaxing nuclei is detected by a radio receiver
4) it is based on the proton magnetization transfer effect of the transmission ionizing radiation
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
ANSWER
A) only the 1st, 2nd and 3rd answers are correct
EXPLANATION
MRI does not use transmission radiation, the others are true
