Psychiatry SAQ Flashcards
1
Q
- A 15 year old boy presents with refusal to go to school. He spends all his time in his bedroom. He has cut ties with his friends. He seems preoccupied and says odd comments.
A. Name FOUR possible diagnoses to explain this presentation.
B. What is ONE important thing to assess for his safety before he leaves your office?
A
A. DDx
- Depression
- Anxiety
- Psychosis
- Substance use
B. SI
2
Q
- Name 5 things that would make you suspect the diagnosis of Munchausen by proxy.
- Define Munchausen by Proxy, and 3 typical features
A
- Definition: parent simulates or causes disease in child
- Features
- Reported Sx repeatedly noted by only one parent
- Appropriate testing fails to confirm a Dx
- Seemingly appropriate Tx is ineffective
- Child’s Sx, course, or response to Tx is not compatible with any recognized disease
- Often preverbal children involved
- Deceptive behaviour is evident even in absnece of obvious external rewards
- Common presentations: bleeding, sz, apnea, GI, skin conditions, recurrent sepsis
- Careful documentation, close monitoring, CAS
3
Q
- Teenage girl w/ suicide attempt who took Tylenol. Ready to leave it’s Friday and she lives in remote area w/ no access to services on weekend. Name 5 components to the safety plan you would establish with her prior to her being seen next?
A
- Parents to remove or lock access to medications, weapons, or other potential methods
- Assess for SI + safety. Contract to safety until F/U
- Encourage communication between her and her parents about SI
- Make sure F/U planned for after the weekend and pt willing to attend
- Helpline services or ED open
4
Q
- 10 year old boy who is inattentive, impulsive and getting poor grades in school. He’s been on ADHD med with good compliance x 2 years with no improvement in his symptoms. Name 5 other possible diagnosis.
A
- ODD
- Depression
- Anxiety
- Learning disability
- Vision or hearing impairment
- OSA
- Hyperthyoridism
5
Q
- A teen comes out to you that he’s gay. Name 5 social/emotional/psychological conditions he’s at risk for.
A
- Depression
- Anxiety
- Suicidal ideation and attempts
- Bullying
- Substance abuse
- STIs
- Assault
6
Q
6 .Kid with shortness of breath, tingling sensation in fingers; just moved the area
a. What’s the diagnosis?
b. What 3 things can you do for management?
A
A. Panic attack
B.
- Mindfulness techniques + breathing into bag
- CBT
- Assess for mood and anxiety disorders
- Consider SSRI
7
Q
- Patient presenting with a diagnosis of ODD.
a. Not including pharmacologic therapy, state two behavioural recommendations for the parents:
b. What are 2 co-morbidities he is at risk for?
A
a) Parent management training
- Positive reinforcement: Consistent praise and rewards for desired behaviours.
- Differential attention: Consistent ignoring unwanted behaviours or discipline for destructive behaviours
- Effective instruction giving
- Consistency across caregivers, situation + settings
b)
- ADHD
- Conduct disorder
8
Q
- List four behaviours suggestive of conduct disorder.
A
- Theft or deceitfulness
- Rule breaking
- Aggression to animals + people
- Property destruction
9
Q
10 What are 2 features of an obsession in OCD that distinguish it from everyday worries.
A
- Obsession
- Recurrent + persistent thoughts, urges or images experienced as intrusive or unwanted, causes anxiety/distress
- Tries to ignore or suppress these thoughts or neutralize it with another thought or action
- Time consuming and affects function
10
Q
- A kid with a past history of anxiety, expressed as headaches and abdominal pains. Has an appendectomy and is off school for 10 days. Now refusing to go back to school. Is otherwise well. What 4 steps do you take in getting him back to school?
A
- Reassure of his physical health
- Return to school immediately - longer that he stays away, harder it is to return
- No positive reinforcements for staying at home
- Assess and address underlying reasons for not returning. Work wtih school personnel as children often need extra attention at school
- Parent management training + family therapy
11
Q
- The parents of a 16 year old boy are concerned because for the last few weeks he says odd things and is spending a lot of time in his room. He does not want to go to school anymore and doesn’t want to see his friends. What are four possible diagnoses?
A
- Substance abuse
- Depression
- Anxiety
- Psychosis
- Brief psychotic disorder <1mo
- Schizophreniform 1-6mo
- Schizophrenia >6mo
- CNS infection
- Encephalitis
- Brain tumour
- MEdications (e.g. steroids)
- THyroid dysfunction
12
Q
- What are four risk factors in an adolescent male for suicide?
A
- Hx of previous suicide attempt!
- Recent stressor
- Hx of mental ilness
- Impulsivity
- Self harm beaviours
- Family conflict + poor parent child communication
- Identifies as homosexual
- Lack of access to psychosocial supports
13
Q
- Parents are worried their teen daughter is depressed. Name 5 questions you would ask the girl to investigate for depression.
A
- Mood
- Sleep disturbance
- Intests - lack of
- Guilt
- Energy low
- Concentration poor
- Appetite change
- Psychomotor retardation
- SI
14
Q
15.
A. Define obsession and give an example (1 line for each).
B. Define compulsion and give an example (1 line for each).
C. What is the most important feature needed for the diagnosis of OCD?
A
A. Obession
- Recurrent +persistent thought, images, urges that is experienced as intrusive and unwanted. Causes marked anxiety/distress.
- Tries to suppress or neutralize thought/idea/urge with another thought or action
- E.g. fear of contamination
B. Compulsion
- Repetitive behaviour or mental acts that individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
- Behaviours or mental acts are aimed at reducing anxiety or distress, preventing some dreaded event or situation. However not connected realistically or excessve.
- E.g. Handwashing
C. Time consuming or cause clinically significant impairment in social, occupation, or other important areas of functioning
15
Q
- 8 year old boy is manipulative, argumentative & vindictive. He gets suspended from school. He throws temper tantrums. Diagnosis? Give 2 management strategies.
A
A. ODD
B. 1. Parent management training
- Social-emotional skills training for child
- Assess for comorbidities and treat
