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Question 1
Incorrect
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A 22 year old female presents to the ER with a respiratory infection for which the physician prescribes her azithromycin. She, however, is currently on combined oral contraceptive pills. Regarding her contraception, what should be advised to this patient?
Your Answer: Using 14d condoms after antibiotics
Correct Answer: No extra precaution
Explanation:Rifampicin is the only antibiotic that has been reported to reduce plasma oestrogen concentrations. When taking Rifampicin, oral contraceptives cannot be relied upon and a second method of contraception is mandatory. Amoxicillin, ampicillin, griseofulvin, metronidazole and tetracycline have been rarely associated with contraceptive failure. When these agents are used, the clinician should discuss the available data with the patient and suggest a second form of birth control. Other antibiotics are most likely safe to use concomitantly with oral contraceptives.
The danger with COCP is enzyme inducers which can lower the levels of the hormone in he blood, azithromycin is not an enzyme inducer. No additional precautions are required to maintain contraceptive efficacy when using antibiotics that are not enzyme inducers with combined hormonal methods for durations of 3 weeks or less. The only proviso would be that if the antibiotics (and/or the illness) caused vomiting or diarrhoea, then the usual additional precautions relating to these conditions should be observed.Inducers: RASAG
– Rifampicin
– Anticonvulsants, particularly phenytoin, carbamazepine, phenobarbitone and primidone
– Spironolactone, St Johns wort
– Alcohol, long term
– Griseofulvin -
This question is part of the following fields:
- Mental Health
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Question 2
Correct
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A 30-year-old woman was brought by family members claiming that she was having increased sexual urges. She has had several sexual encounters with unknown people and is spending a lot of money on clothes and jewellery. On examination, she was talking excessively. Family members gave a history of low mood and an attempted suicide a few months ago. What is the most probable diagnosis?
Your Answer: Bipolar affective disorder
Explanation:This patient has features of mania including increased sexual activity, excessive pursuit of pleasurable activities and excessive talking. There is a history of a depressive episode as well (low mood and suicidal attempt). Therefore, this patient most likely has a bipolar affective disorder.
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This question is part of the following fields:
- Mental Health
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Question 3
Incorrect
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A 37 year old female who is admitted to the psychiatric ward claims that the other patients and staff are aware of her thoughts and know exactly what she is thinking all the time. Which of the following is the most likely symptom this patient is suffering from?
Your Answer: Thought Broadcasting
Correct Answer: Thought Withdrawal
Explanation:In psychiatry, thought withdrawal is the delusional belief that thoughts have been ‘taken out’ of the patient’s mind, and the patient has no power over this. It often accompanies thought blocking.
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This question is part of the following fields:
- Mental Health
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Question 4
Correct
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A 32-year-old man on psychiatric medications complains of the inability to ejaculate. Which drug is most likely to cause these symptoms?
Your Answer: Fluoxetine
Explanation:SSRIs such as fluoxetine are commonly associated with delayed ejaculation.
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This question is part of the following fields:
- Mental Health
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Question 5
Correct
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A 24 year old male comes to the clinic with a history of drug abuse. He says that he is aware that he has a problem and would like to see a psychiatrist. Which of the following best describes this?
Your Answer: Insight
Explanation:In psychology and psychiatry, insight can mean the ability to recognize one’s own mental illness. A person with very poor recognition or acknowledgment is referred to as having poor insight. The most extreme form is anosognosia, the total absence of insight into one’s own mental illness. Insight can be defined not only in terms of people’s understanding of their illness, but also in terms of understanding how the illness affects individuals’ interactions with the world. The term ‘insight’ encompasses a complex concept which should not be considered as an isolated symptom which is present or absent. Instead, it may be more appropriate to think of insight as a continuum of thinking and feeling, affected by numerous internal and external variables. Different psychiatric disorders involve different mechanisms in the process of impairment of insight; this may influence the ways in which insight should be assessed in clinical practice.
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This question is part of the following fields:
- Mental Health
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Question 6
Incorrect
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A 29-year-old woman presented 10 days post-partum with loss of weight. On history taking, the patient complains of loss of appetite and a lack of sympathy for her child. She is always tired. She even sometimes has violent thoughts about hurting her baby. The treatment of choice for such a case would be?
Your Answer: Haloperidol
Correct Answer: ECT
Explanation:This is a case of postpartum psychosis. It can be treated with antidepressants, mood stabilisers or ECT. The treatment of choice is ECT.
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This question is part of the following fields:
- Mental Health
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Question 7
Correct
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A 30-year-old female came to the emergency department complaining of recurrent episodes of fearfulness, palpitations, faintness, hyperventilation, dryness of the mouth with peri-oral tingling and cramping of the hands. These symptoms generally last 5-10 mins and have worsened since their onset 3 months ago. An ECG shows sinus tachycardia. What is the single most appropriate immediate intervention?
Your Answer: Rebreathe into a paper bag
Explanation:History is suggestive of a panic attack which causes her to hyperventilate. This has washed out the CO2 leading to a respiratory alkalosis. This causes increased calcium ion binding to albumin and a reduction of free calcium in the blood which causes peri-oral tingling and cramping of the hands. These symptoms can be improved by rebreathing into a paper bag which will reverse the above mechanism.
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This question is part of the following fields:
- Mental Health
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Question 8
Correct
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A 59 year old, visibly anxious appearing female presents to the clinic with marked urinary incontinence. Urine culture comes out to be sterile and the urodynamic study is normal. Which of the following would be the next step in the management of this case?
Your Answer: Pelvic floor exercise
Explanation:Urinary incontinence is a common condition characterized by uncontrollable leakage of urine. Causes and presentation are variable.
Stress incontinence, urge incontinence, and mixed incontinence are the most frequent forms. The condition is twice as common in women as men.
Diagnosis involves a detailed medical history, a voiding diary, physical examination, and diagnostic testing such as measurement of the bladder pressure (urodynamic examination).
Treatment is determined based on the type of incontinence and its aetiology, and usually involves measures such as pelvic floor physiotherapy, anti-incontinence devices, anticholinergics, or collecting devices. The prognosis in adequately treated cases is usually excellent, but, if left untreated, constant contact with leaked urine can cause urinary tract infections, dermatitis, and psychological distress. -
This question is part of the following fields:
- Mental Health
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Question 9
Correct
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A 27-year-old female claims that a famous actor is in love with her and sends her extravagant gifts regularly. However, close family say this is not the case. Which of the following is the most likely diagnosis?
Your Answer: Erotomania
Explanation:Erotomania is characterized by an individual’s delusion of another person being infatuated with them.
Pyromania is characterized by intentional and repeated fire setting.
Kleptomania is characterized by repeated, failed attempts to stop stealing.
Trichotillomania is characterized by recurrent, irresistible urges to pull out ones hair.
Grandiosity is characterized by an unrealistic sense of superiority. -
This question is part of the following fields:
- Mental Health
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Question 10
Correct
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A 47-year-old man is extremely agitated as he thinks he is under arrest for a crime he did not commit. He cannot focus or remember recent events. He admits alcohol abuse over the past 20 years. The most likely diagnosis is?
Your Answer: Korsakoff psychosis
Explanation:Short term memory loss (aka dementia) is a sign of Korsakoff psychosis.
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This question is part of the following fields:
- Mental Health
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Question 11
Correct
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A 41-year-old woman has been feeling down lately. She has been avoiding social events and has a strong family history of depression. Which of the following increases her suicidal tendency?
Your Answer: Past history of overdose
Explanation:A large prospective study identified hopelessness, higher levels of suicidal ideation, recurrent episodes of depression, presence of personality disorders, previous psychiatric hospitalisation, older age, unemployed status and a family history of suicide as significant markers for suicide. Having one or more previous suicide attempts is a very strong predictor of suicide risk.
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This question is part of the following fields:
- Mental Health
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Question 12
Correct
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A 49 year old male has recently lost his job and has, therefore, become homeless. He was heard speaking under his breathe about people being 'after him'. He was tested for alcohol, but the test came back negative. From the list of options, choose the most appropriate next step.
Your Answer: Neuro psychiatric analysis
Explanation:Neuropsychic analysis is the most logical approach to this situation, as this patient is presenting with persecutory delusions. This indicates that he is likely to be suffering from psychosis.
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This question is part of the following fields:
- Mental Health
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Question 13
Correct
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A 25-year-old woman with long-term bipolar disorder is experiencing Hypothermia, weight gain, lethargy. Which psychotropic medication would you associate these side effects?
Your Answer: Lithium
Explanation:Lithium is the medication used for a wide range of mental illnesses such as schizophrenia, depression, and bipolar disorders. It is famous for its side effects which includes a number of thyroid disorders (hypothyroidism, hyperthyroidism, and thyroiditis).
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This question is part of the following fields:
- Mental Health
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Question 14
Correct
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A newly married lady was brought to the hospital with aggressive behaviour and a history of an intake of 100 paracetamol tablets, however she states that she is okay and has no symptoms. The most appropriate action to take will be?
Your Answer: Detain under Mental Health Act
Explanation:She should be detained under the mental health act because she has attempted suicide once before, so she needs to be kept under close observation.
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This question is part of the following fields:
- Mental Health
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Question 15
Correct
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A 1 year old child presents with barking cough, coryza and shortness of breath. What will be the most likely outcome associated with this condition?
Your Answer: Natural resolution
Explanation:Croup is the most common aetiology for hoarseness, cough, and onset of acute stridor in febrile children. Symptoms of coryza may be absent, mild, or marked. The vast majority of children with croup recover without consequences or sequelae.
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This question is part of the following fields:
- Mental Health
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Question 16
Incorrect
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A 21-year-old medical student presented with increased urge to wash his hands for 2 weeks. He could not concentrate on his studies, as he wanted to wash hands every 15-20 minutes. Although he knew it was a pointless exercise, he could not resist it. Which of the following is the most appropriate management for this condition?
Your Answer: Selective serotonin re-uptake inhibitors (SSRI)
Correct Answer: Cognitive behaviour therapy
Explanation:The given history is compatible with obsessive-compulsive disorder, which is characterized by distressing, intrusive obsessive thoughts and/or repetitive compulsive physical or mental acts. Cognitive behavioural therapy is the mainstay of treatment.
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This question is part of the following fields:
- Mental Health
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Question 17
Incorrect
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A 37 year old female who is admitted to the psychiatric ward claims that the other patients and staff are aware of her thoughts and know exactly what she is thinking all the time. Which of the following is the most likely symptom this patient is suffering from?
Your Answer: Thought withdrawal
Correct Answer: Though broadcasting
Explanation:In psychiatry, thought broadcasting is the belief that others can hear or are aware of an individual’s thoughts. Thought broadcasting can be a positive symptom of schizophrenia.
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This question is part of the following fields:
- Mental Health
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Question 18
Incorrect
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An 18 year-old female is brought in by her worried parents. She has a BMI of 12 but is otherwise happy with her weight. What is the next best step to help this girl?
Your Answer: Psychiatric referral for admission
Correct Answer: Medical admission
Explanation:Anorexia nervosa, commonly referred to as anorexia, is an eating disorder characterized by low body weight, a distortion of the perception of body image, and an obsessive fear of gaining weight. A BMI below 17.5 in adults is one of the common physical characteristics used to diagnose anorexia. There are also different tiers of anorexia based on BMI ranging from mild (<17.5), moderate (16-16.99), and severe (15-15.99), to extreme (<15). A BMI below 13.5 can lead to organ failure, while a BMI below 12 can be life threatening. At this critical low BMI medical admission is indicated to improve her deficiency states and for proper nutrition.
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This question is part of the following fields:
- Mental Health
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Question 19
Incorrect
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A young boy presents with a soft swelling in the midline neck that moves with tongue protrusion. The swelling is present between the thyroid cartilage and the tongue. Which of the following is the most likely diagnosis?
Your Answer: Goitre
Correct Answer: Thyroglossal cyst
Explanation:The thyroglossal duct cyst is the most common congenital anomaly of the central portion of the neck. The thyroglossal duct cyst is intimately related to the central portion of the hyoid bone and usually elevates along with the larynx during swallowing. Thyroglossal cysts can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during the developmental stages.
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This question is part of the following fields:
- Mental Health
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Question 20
Incorrect
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A 6 month old infant has developed jaundice from breast milk. He is otherwise healthy with no signs of dehydration. His LFTs will most likely show which of the following pattern?
Your Answer: Total bilirubin: 400, conjugated bilirubin <85%
Correct Answer: Total bilirubin: 40, conjugated bilirubin < 5%
Explanation:Breast milk jaundice is a type of jaundice associated with breast-feeding. It typically occurs one week after birth. The condition can sometimes last up to 12 weeks, but it rarely causes complications in healthy, breast-fed infants. The exact cause of breast milk jaundice isn’t known. However, it may be linked to a substance in the breast milk that prevents certain proteins in the infant’s liver from breaking down bilirubin. The condition may also run in families. Breast milk jaundice is rare, affecting less than 3 percent of infants. When it does occur, it usually doesn’t cause any problems and eventually goes away on its own. It’s safe to continue breast-feeding.
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This question is part of the following fields:
- Mental Health
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Question 21
Correct
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A 50 year old man was brought in by his wife. She said that her husband kept talking about a thing which was inside his head and improving his thinking power. She wanted that thing to be removed from his head but her husband wanted to keep it and refused treatment. Which of the following is the most appropriate next step?
Your Answer: Assess his mental capacity to refuse treatment
Explanation:There is a high possibility that the man his suffering from a psychiatric illness. His mental capacity should be assessed to know whether he is in a position to refuse any intervention.
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This question is part of the following fields:
- Mental Health
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Question 22
Incorrect
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Which of the following statements reflects the aetiology and dynamics of schizophrenia most accurately?
Your Answer: In monozygotic twins the risk of the second twin developing schizophrenia if the first is affected is of the order of 10%
Correct Answer: Schizophrenia is commoner in individuals not in stable relationships
Explanation:According to the survey, schizophrenia is twice as common in individuals who are not in stable relationships or are single/divorced, as compared to happy couples.
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This question is part of the following fields:
- Mental Health
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Question 23
Correct
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A 35-year-old woman with no psychiatric history has attempted suicide 10 times. Her neurological examination is apparently normal. What would be the most appropriate management?
Your Answer: Problem focussed treatment
Explanation:Problem focussed treatment focuses on solutions to the problem, rather than on the problem itself that brought patients to seek therapy, in this case the suicide attempts. The patient seems to be parasuicidal which is a feature of some personality disorders such as histrionic and borderline personality disorders which do not require medical treatment but psychotherapy.
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This question is part of the following fields:
- Mental Health
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Question 24
Correct
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A 24 year old woman complains of an inability to stop thinking about saving water, and has to keep checking the tap all the time. What is the diagnosis?
Your Answer: Obsessive compulsive disorder (OCD)
Explanation:Intrusive thoughts and urges, and the compulsion to do a repeated action (such as checking the tap) are consistent with OCD.
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This question is part of the following fields:
- Mental Health
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Question 25
Incorrect
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A 33 year old male patient has a history of recurrent hospital admissions. The reason for his admissions was described as palpitations in the context of anxiety or panic attacks. He occasionally experiences tremors and high blood pressure. He's also noticed he's been losing weight persistently. What is the most likely diagnosis?
Your Answer: Hyperthyroidism
Correct Answer:
Explanation:Pheochromocytoma is a benign tumour of the adrenal glands. Characteristically it causes high blood pressure. It is a rare condition that can mimic panic attacks in the sense that it produces sympathomimetic symptoms together with weight loss, headaches and tremor. The clinical picture might be mistaken for other anxiety syndromes.
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This question is part of the following fields:
- Mental Health
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Question 26
Incorrect
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A 28-year-old male is admitted to the psychiatry ward for aggressive behaviour. He has distressing auditory hallucinations and was diagnosed with schizophrenia previously. Now he has broken his bed and refused to take any oral medications. The injectable drug of choice in this case is?
Your Answer: Haloperidol
Correct Answer: Risperidone
Explanation:The algorithm of treatment of agitated violent patients . First try using verbal communication to calm down the patient, if this doesn’t work offer oral olanzapine or oral risperidone. IF oral agents do not work opt for IV olanzapine or risperidone. IM olanzapine or risperidone may be given if agitation persists. The last resort in this case is IV haloperidol. If rapid sedation is required , IV diazepam can be given.
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This question is part of the following fields:
- Mental Health
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Question 27
Correct
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A 15 year old girl is brought to the emergency after collapsing at a shopping mall. She is accompanied by her mother who reveals that she has had amenorrhea for the past 7 consecutive months. There is fine hair on her body. Which of the following investigations is mandatory in this case?
Your Answer: Urea & Electrolytes
Explanation:Although some individuals with Anorexia Nervosa exhibit no laboratory abnormalities, the semistarvation characteristic of this disorder can affect most major organ systems and produce a variety of disturbances. The induced vomiting and abuse of laxatives, diuretics, and enemas can also cause a number of disturbances leading to abnormal laboratory findings.
Haematology: Leukopenia and mild anaemia are common; thrombocytopenia occurs rarely.
Chemistry: Dehydration may be reflected by an elevated blood urea nitrogen (BUN). Hypercholesterolemia is common.
Liver function tests may be elevated.
Hypomagnesemia, hypozincaemia, hypophosphatemia, and hyperamylasaemia are occasionally found.
Induced vomiting may lead to metabolic alkalosis (elevated serum bicarbonate), hypochloraemia, and hypokalaemia, and laxative abuse may cause a metabolic acidosis.
Serum thyroxine levels are usually in the low-normal range; triiodothyronine levels are decreased.
Hyperadrenocorticism and abnormal responsiveness to a variety of neuroendocrine challenges are common.
In females, low serum oestrogen levels are present, whereas males have low levels of serum testosterone.
There is a regression of the hypothalamic-pituitary-gonadal axis in both sexes in that the 24-hour pattern of secretion of luteinizing hormone (LH) resembles that normally seen in prepubertal or pubertal individuals. -
This question is part of the following fields:
- Mental Health
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Question 28
Correct
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A 25 year old female was brought in with multiple superficial lacerations on her non-dominant forearm. There was evidence of older but similar kind of injuries to the same forearm. She was in distress as her boyfriend wanted to end the relationship. She didn't have any suicidal thoughts. Which of the following is the most probable diagnosis?
Your Answer: Borderline personality disorder
Explanation:According to this presentation the most likely diagnosis is borderline personality disorder. The patient has impulsivity, self-harm and instability of interpersonal relationships, which are suggestive of borderline personality disorder. The history is not adequate to diagnose the other given conditions.
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This question is part of the following fields:
- Mental Health
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Question 29
Incorrect
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A woman presents with several painful ulcers on her vulva. What do you think has most likely caused this?
Your Answer: Chlamydia
Correct Answer: HSV
Explanation:Genital herpes is a sexually transmitted disease (STD). This STD causes herpetic sores, which are painful blisters (fluid-filled bumps) that can break open and ooze fluid.
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This question is part of the following fields:
- Mental Health
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Question 30
Correct
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A 35 year old female was afraid of being at crowded places such as supermarkets, trains etc. She felt extreme anxiety at such places and started avoiding such places. Physical examination was normal. Which of the following is the diagnosis of this condition?
Your Answer: Agoraphobia
Explanation:Agoraphobia is a psychiatric disorder that results from anxiety regarding and avoidance of situations such as crowds, shopping malls, public transportation, and being away from home.
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This question is part of the following fields:
- Mental Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
