Select whether each statement is true or false
Q1. A 21-year old gentleman is admitted to the psychiatry ward for wrecking his neighbors car. On further questioning, he reveals that the reason for this act is because he believes that the neighbor is conspiring with the government to do something bad to him, though he could not provide further details. He can also hear unknown people talking about his every movement.
The following therapies may benefit this patient in his current state.
A. Behavioral therapy
B. Supportive psychotherapy
C. Cognitive behavioral therapy
D. Psychodynamic psychotherapy
E. Rational Emotive Behavior Therapy (REBT)
Q2. The following factors are said to increase the risk of schizophrenia
A. Being born in a city
B. Being born post-date
C.Being born in summer
D. Migrating to another country
E. History of traumatic brain injury
Q3. You are the doctor in charge of a 21-year old young man who was admitted for relapsed schizophrenia. In view of his poor response to 2mg of haloperidol, persistent auditory hallucinations and tendency for aggression, you decide to increase his medication to 6mg haloperidol daily. Your nurse informs you the next day that this patient has a fever, stiff upper limbs and a blood pressure of 150/100.
Which of the following investigations are most urgently indicated in this patient?
A. Urine analysis
B. Creatine Kinase
C. Full Blood Count
D. Arterial blood gas (ABG)
E. Electro-encephalogram (EEG)
Q4. A 21-year old lady believes that she was sent by God to alleviate the pains of all men and started giving away money to everyone she met. Three months earlier she believed that God had abandoned her and that she was worthless.
The following medication may be considered for this patient:
Q5. The following are true regarding alcohol use disorder
A. Wernicke’s encephalopathy may be reversed with proper treatment
B. Most people who present with wernicke’s encephalopathy eventually progress to Korsakoff syndrome
C. Delirium tremens is associated with a 20% mortality rate
D. Macrocephaly is a possible feature of foetal alcohol syndrome
E. Only 10% of people with Wernicke’s encephalopathy present with all three of the triad of ophthalmoplegia, ataxia and confusion
Q6. A 55-year old teacher who is married with two adult daughters who has a history of bipolar mood disorder presents to the emergency department claiming that she is in relapse. She is verbally abusive to the staff sings loudly in the waiting area. She demands to be admitted to the psychiatry ward.
The forms that can be used to admit her to the psychiatry ward are
A. Form 1 and form 2
B. Form 3 and form 4
C. Form 5 and form p57
D. Form 1 and form 3
E. Form 2 and form 4
Q7. You are the doctor in charge of a 43-year old gentleman with schizophrenia who was admitted for wandering around town naked. He talks very little, does not mix with other patients nor join in daily ward activities, does not bathe and has to be instructed to eat. He spends most of the time lying on the bed. You do not notice any marked hallucinatory behavior.
Which of the following treatments may be helpful for this patient’s main problems
A. Add haloperidol
B. ADL training
C. Social skills training
D. Refer for occupational therapy
E. Cognitive behavioral therapy
Q8. The following are associated with an increased suicide risk
B. Stated future attempt of repeating suicide
C. Good social support
D. Depression with psychosis
E. Organised suicidal plan
Q9. Regarding obsessive compulsive disorder
A. Escitalopram may be helpful
B. Obsessive thoughts are egodystonic
C. Repeated door checking is an example of an obsession
D. Its severity may be measured by the Y-BOCS scale
E. Exposure response prevention is one of the treatments of choice
Q10. Regarding alcohol use disorder
A. Nystagmus may develop in alcohol intoxication
B. The CAGE questionnaire may be used as a screening tool
C. The 12-48H period after last drink is the critical period where seizures may develop in alcohol withdrawal
D. Long acting benzodiazepines are the treatment of choice for alcohol withdrawal
E. According to DSM 5, at least TWO (2) criterion C symptoms must be present to warrant a diagnosis of alcohol intoxication
One best answer (OBA)
Select ONE (1) best answer for each of the following questions
Q1. A 25-year old teacher with underlying bipolar type 1 comes to the clinic after stopping medication for two years due to a recent onset of sleeplessness, irritability and a sense of having a lot of ideas. She and her husband request to restart her medication. Her last medication was sodium valproate which she tolerated well. She is six weeks pregnant with her third child.
Which of the following is the best medication on which to start her on?
A. Sodium valproate
E. Combination of sodium valproate and risperidone
Q2. A 23-year old odd jobs worker was brought to the emergency department for sudden onset of aggressive behavior for the past three days. His father notes that he started working as a laborer two weeks ago which was when he started behaving oddly. This is the first time that he is experiencing such symptoms. He has a second cousin twice removed who has mental illness.
Which is the most important investigation in this patient?
A. Brain CT scan
B. Urine toxicology
C. Genetic testing for 22q11 microdeletion
D. Blood culture and sensitivity
E. Full blood count
Q3. A 28-year old lady complains to you of amenorrhoea for the past five months.
Which medication is most likely to have caused this?
Q4. A 26-year old lawyer was brought to the hospital by her husband after she threw a porcelain set at him and attempted to hit their five year old daughter with a stick. Further history reveals that she has been having trouble sleeping for the past two weeks and has been growing irritable and aggressive for the past one week. One month before that she had been very quiet and stopped going to work because of excessive sleep.
Which of the following medications would best serve this lady?
Q5. You attend to a 35-year old gentleman who had a sudden attack of breathlessness while waiting at the psychiatry clinic. He tells you that just prior to the attack of breathlessness, he had palpitations, chest pain and a sense of chocking. These symptoms come several times a day and he is always apprehensive about when the next attack will be coming. As a result, he avoids going to crowded places because he is afraid of having an attack there. These symptoms began one year ago after he almost got into a road traffic accident.
What is the most appropriate diagnosis?
A. Panic attack
B. Social phobia
D. Panic disorder
E. Post-traumatic stress disorder
A 45-year old Irish tourist was brought in by the police after fondling a lady at a bar and assaulting the other patrons when they tried to stop him. He was still combative on arrival and was given haloperidol and midazolam by the emergency team.
On examination you notice that he has a bad breath, speaks incoherently and has trouble keeping his balance.
Q1. What is you provisional diagnosis?
Q2. What is the full DSM 5 criteria for the diagnosis you gave in Q1.
Q3. The gentleman is still groggy when you review him several hours later and vomits on the bed. You notice that his hands are shaking and he appears anxious. What is the syndrome that this patient is experiencing now?
Q4. Name two life threatening sequelae that you should watch out for in this gentleman.
Q5. What class of medication can you use to manage this gentleman? Name two examples of this class of medication that can be used to treat this patient.