Psychiatry .

Psychiatry Final Questions 2010-2012

1) A patient with hallucinations & extreme agitation, his urine screen was positive for phenylcyclidine (PCP). Which is best for his severe agitation?1. + Haloperidol1. Citalopram1. Fluoxetine1. Triptyline-- PCP is stimulant. only haloperidol is antipsychotic here2) A patient had commanded suicide hallucinations. He was treated with high dose haloperidol then developed torticollis. The best treatment is:1. +Kemadrin (procyclidine)1. Low dose neuroleptics1. Acetaminophen-- muscle relaxant3) Echolalia, echopraxia and catalepsy are signs of which subtype of schizophrenia?1. Undifferentiated1. +Catatonic1. Paranoid 1. Disorganized1. Residual-- has been dropped from DSV 5

4) If a patient had schizophrenia, risk of his brother to develop schizophrenia is:1. +10%1. 5%1. 20%1. 30%-- risk for FDR to have schizophrenia is 10% same with monozygotic twin5) 25 years old male was in good health. Now he complains of anhedonia; his mother died since 1 month, so now he is extremely sad & tearful. He lost 3 lb and he can't sleep at night. Most likely the patient developed:1. Adjustment disorder1. PTSD1. +Uncomplicated bereavement1. Major depression1. Dysthymic disorder-- duration of one month is important to diagnose6) Parents of a 4-year-old girl presented her because they think she has abnormal development. She developed normally until 2-3 years, she spoke words & sentences, & used to play with her mother. Now since 3 months, she lost what she developed, doesnt speak at all, doesnt play, & lost bowel continence after which she was free of diaper almost 1 year. She is most likely to have:1. +Child disintegrative disorder1. Autism1. Retts disease1. Asperger's disease1. Pervasive developmental disorder -- Childhood disintegrative disorder, also known as Heller's syndrome is a very rare condition in which children develop normally until at least two years of age, but then demonstrate a severe loss of social, communication and other skills.

7) An 8 years old child becomes very distressed & tearful every morning before school. She complains of abdominal pain, and if she goes to school, she continues complaining so that her mother goes many times and takes her home early. She takes many days off school with same complaints. Her signs disappear on weekends unless her parents went out and left her with a babysitter. The child mostly has:0. +Separation anxiety disorder0. Attachment disorder0. Generalized anxiety-- attachment disorder definition: child has impaired social interactions that are due to pathologic parenting and not due to an autism spectrum disorder.8) A middle aged man, preoccupied with his health, is always concerned that his abnormal bowel movement indicates cancer. Recently he is worried about having MI although his doctor gives him reassurance & his tests are normal all the time. The patient mostly has:1. +Hypochondriasis1. Conversion 1. Somatization-- hypochondriasis is excessive worrying of a specific disease/diagnosis9) 19 years old, college student, had urinary incontinence which improved slowly over few weeks. Now she presented with blurred vision in her right eye after breakup with her boyfriend. She mostly has:1. +Somatoform disorder1. Multiple sclerosis-- recurring, multiple, clinically significant physical complaints which result in patient seeking treatment or having impaired functioning

10) A female was referred to a psychiatric clinic after she called the police to take her because she was responsible for her neighbor abortion. She said that she had thoughts about her neighbor having abortion, and she feels threatened from her neighbor because she thinks that her thoughts are heard across the walls. The patient believes that her thoughts of her neighbor abortion could make it happen. This is called:1. Magical thinking1. Displacement1. Projection1. Ideas of reference1. +Thought broadcasting-- She believes others can read her thought

11) A 12-year-old female complains of abnormality in her face that her eyes are too far from each other and her nose is misshapen. She avoids people because she doesnt want them to notice the abnormality. Doctors say that she had nothing wrong. The patient has:1. +Body dysmorphic disorder1. Obsessive compulsive disorder-- preoccupation with imagined defect in appearance or excess concern around a slight anomaly 12) Difference between malingering & conversion is:1. +Malingering refuses treatment & evaluation while conversion is eager for treatment1. Malingering is subconscious & conversion deliberately feigning sign1. Malingering looks for primary gain, conversion looks for secondary gain1. Malingering are cooperative & friendly, conversion are non cooperative-- malingering is consciously done and not cooperative. Conversion looks for both.

13) A 72-year-old female was brought in because she didnt eat anything since 2 days. She resists to be moved, she is motionless, and doesnt respond to stimulus (verbal or non-verbal) and she previously said things that dont make sense. The patient most likely has:1. Schizoaffective2. +Catatonia3. Cataplexy4. Delusion disorder5. Schizophreniform

Catatonic type : at least 2 of the following : (1)motor immobility (2)excessive purposeless motor activity (3)extreme negativism/mutism (4)peculiar voluntary movement or posturing (5)Echolalia/EchopraxiaCataplexyis a sudden and transient episode of muscle weakness accompanied by full conscious awareness, typically triggered by emotionsSchizoaffective : Schizophrenia + mood disorder.Schizophreniform : last 1-6 monthsDelusional disorder : Nonbizzare delusion at least 1 month, not impaired life function

14) A 52-year-old male had depressed mood, lost weight, and recently hears his dead father voice blaming him for his faults and telling him that he is useless. The patient believes that the inside of his body is rotting. This patient should be:1. +Started on SSRI & antipsychotic2. Started on SSRI alone3. Patient had acute attack of schizophreniaThe patient had depression with psychosis (auditory hallucination + delusions). So, we treat both.15) To note vocal tics when observed:1. Echolalia2. +Coprolalia3. PalilaliaCoprolalia : repetitive speaking of obscene words.In the book, vocal tics include Coprolalia and Echolalia.??

16) A female complains that she sees little people walking around her house, she also saw one of these little people in the doctor's clinic while waiting. This is called:1. +Hallucination2. Hallucinogen3. IllusionHallucination : Perception in absence of an external stimulus.Illusion : misinterpretation of an external stimulus.

17) A female doesnt remember much about her childhood except that she was taken away from her native parents because of abuse & neglect. Now she doesnt account for a lot of hours & even days of her life. She finds cloths in her closet she haven't bought, and her friends feel strange about her because she sometimes acts childish and other times she is very aggressive. The patient has:1. +Identity dissociative disorder 2. Disassociated Amnesia3. Korsakoff dementiaIdentity Dissociative Dis. : (1)has 2 or more distinct identities (2)inability to recall personal information of one personalityDissociated Amnesia : amnesia only, inability to recall important personal info, and impaired daily function.Korsakoff dementia : neurological disorder due tu lack of thiamine (vit B1) or viral encephalitis

18) An 11-year-old adopted boy, his biological mother was alcoholic, was in a special school because he had learning difficulties. On measuring his IQ, it was 60. We classify him in which type of mental retardation?1. +Mild Mental Retardation2. Moderate Mental Retardation3. Severe Mental Retardation*from wiki, severity of intellectual disability. (different from the book)TypeMildModerateSevereProfound

IQ69-5049-3534-20 2 months during those 2 years.No history of major depressive episode or manic episodeSource;slide seminar

Q41. The use of one of the following mood stabilizers is associated with increased prevalence of polycystic ovary syndrome:a) (+)Valproateb) Lamotriginec) Lithiumd) Carbamazepinee) Topiramate-increased prevalence of polycystic ovary syndrome (PCOS) associated with valproate(VPA) use has been reported in both women with epilepsy and women with bipolar disorders.source: http://www.ncbi.nlm.nih.gov/pubmed/19012099

Q42. A talented 21-year-old violinist's musical career is in jeopardy because he becomes acutely anxious and distressed whenever he is asked to play in front of an audience where he might have to do something that will embarrass him. What is the most likely diagnosis?a) Specific phobiab) Agoraphobiac) Panic disorderd) Acute stress reactione) (+)Social phobia->is a fear of social situations in which embarrassment can occur.Social anxiety only occurs when the patient is subject to the scrutiny of others (public speaking, oral exam, eating in the cafeteria). May be associated with panic attacks.Source:slide seminar

Q43. A 24-year-old man with chronic Schizophrenia under treatment with antipsychotics is brought to the emergency room after his parents found him in his bed and were unable to communicate with him. On examination, the man is confused and disoriented. He has severe muscle rigidity and a temperature of 39.4 C. his blood pressure is elevated and he has leukocytosis. Which of the following is the best first step in the pharmacological treatment of this man?a) Lorazepam (Short-acting benzodiazepine)b) Haloperidol (typical anti psychotic)c) Benztropined) Lithium (treatment for bipolar disorder)e) (+)Bromocriptine-this is case of neuroleptic malignant syndrome(NMS).patient may have Autonomic instability , Rigidity , myoglubinuria , hyperpyrexia , unstable vitals.treatment for NMS: Dantrolene , D2 agonist (Bromocriptine)Source:slide seminarQ44. A 32-year-old woman is arrested by the police after she is found crawling through the window of a movie star's home. She states that the movie star invited her into his home because the two are secretly married and "it just wouldn't be good for his career if everyone knew". The movie star denies the two have ever met, but notes that the woman has sent him hundreds of letters over the past 2 years. The woman has never been in trouble before and lives an otherwise isolated and unremarkable life. Which of the following is the most likely diagnosis? a) Schizoaffective disorderb) (+)Delusional disorderc) Cyclothymiad) Schizophreniform disordere) Bipolar I disorder

-delusional disorder: 1)Fixed, persistent, non-bizarre untrue belief 2)Lasting more than 1 month (3)Functioning is not impaired (4)No hallucinations or mood disturbances. Ex: a woman who thinks that she is married to a celebrity when in fact she is not.Source:slide seminar

Q45. A 19-year-old man is brought to the emergency room by his parents, who are worried about his vomiting and profuse diarrhea. On arrival, his pupils are dilated, his blood pressure is 170/110 mm Hg, and his muscles are twitching. His parents report that these symptoms started 2 hours earlier. For the past few days he has been homebound because of a sprained ankle, and during this time he has been increasingly anxious and restless. He has been yawning incessantly and has had a runny nose. Which of the following drugs is this person most likely to be withdrawing from?a) Alcoholb) (+)Heroinc) Benzodiazepined) Cocainee) Phencyclidine -heroin is opiod. Opioid withdrawal is a syndrome that follows a relative reduction in heavy and prolonged use. The syndrome begins within 6-8 hours after the last dose and peaks between 48 and 72 hours; symptoms disappear in 7-10 days. The signs and symptoms are the opposite of those of the acute agonist effects: lacrimation, rhinorrhea, pupillary dilation, piloerection, diaphoresis, diarrhea,, mild hypertension, tachycardia, fever, and insomnia ,A flulike syndrome subsequently develops, with complaints, demands, and drug seeking.Source:slide seminar

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