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Question 1
Correct
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A 48-year-old man is brought into the emergency department after attempting to take his own life. He was found at home with empty packets of paracetamol by his side. He is still conscious. A history is taken from him to evaluate his risk of future attempts.
What is the most significant risk factor for a successful suicide?Your Answer: Addiction to opiates
Explanation:Individuals with a history of alcohol or drug abuse and deliberate self harm, particularly males, should be considered at high risk for suicide.
The risk of suicide in psychiatric patients is often stratified into high, medium, or low risk categories, but there is limited evidence on the positive predictive value of individual risk factors. A review in the BMJ concluded that these assessments may not be useful in guiding decision making, as 50% of suicides occur in patients deemed low risk. However, certain factors have been associated with an increased risk of suicide, such as male sex, history of deliberate self-harm, alcohol or drug misuse, mental illness, depression, schizophrenia, chronic disease, advancing age, unemployment or social isolation, and being unmarried, divorced, or widowed.
If a patient has attempted suicide, there are additional factors that increase the risk of completed suicide in the future, such as efforts to avoid discovery, planning, leaving a written note, final acts such as sorting out finances, and using a violent method. On the other hand, there are protective factors that can reduce the risk of suicide, such as having family support, having children at home, and having a religious belief.
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This question is part of the following fields:
- Psychiatry
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Question 2
Incorrect
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You are obtaining a medical history from a frequent visitor to the emergency department, who has a history of alcoholism. He arrived at the department feeling unwell last night. He informs you that he has recently returned from a trip to Hawaii, where he spent the last three weeks. He appears restless as he expresses his desire to go on another vacation tomorrow. However, you recall admitting him to the emergency department just a week ago.
What is your suspicion regarding his motive for sharing this falsehood?Your Answer: Alcohol withdrawal is making him disorientated and confused
Correct Answer: He has an underlying thiamine deficiency
Explanation:Korsakoff’s syndrome is caused by untreated thiamine deficiency, which is also the underlying reason for Wernicke-korsakoff syndrome. Wernicke encephalopathy is an acute neurological deterioration due to thiamine deficiency, while Korsakoff’s syndrome is a chronic neurological deterioration characterized by deficits in memory and confabulation. In this case, the patient’s confabulation is likely due to retrograde memory impairment, which is a feature of Korsakoff’s syndrome. The patient’s history of alcoholism suggests a thiamine deficiency, which can lead to Wernicke-korsakoff syndrome. While alcohol withdrawal is a possible differential, it alone cannot explain the patient’s confabulation. It is important to exclude organic causes before assuming the patient is actively lying.
Understanding Korsakoff’s Syndrome
Korsakoff’s syndrome is a memory disorder that is commonly observed in individuals who have a history of alcoholism. This condition is caused by a deficiency in thiamine, which leads to damage and haemorrhage in the mammillary bodies of the hypothalamus and the medial thalamus. Korsakoff’s syndrome often follows untreated Wernicke’s encephalopathy, which is another condition caused by thiamine deficiency.
The primary features of Korsakoff’s syndrome include anterograde amnesia, which is the inability to acquire new memories, and retrograde amnesia. Individuals with this condition may also experience confabulation, which is the production of fabricated or distorted memories to fill gaps in their recollection.
Understanding Korsakoff’s syndrome is crucial for individuals who have a history of alcoholism or thiamine deficiency. Early diagnosis and treatment can help prevent further damage and improve the individual’s quality of life. Proper nutrition and abstinence from alcohol are essential for managing this condition.
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This question is part of the following fields:
- Psychiatry
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Question 3
Incorrect
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A 30-year-old male presents to a mental health specialist with a belief that the government has taken over his body. He is prescribed an antipsychotic medication. What are the potential side effects of this type of medication?
Your Answer: Renal failure
Correct Answer: Metabolic syndrome
Explanation:Antipsychotics block dopamine receptors, resulting in a broad range of side effects. These may include dystonia, dyskinesia, antiemetic effects, and hyperprolactinemia. Additionally, antipsychotics can cause metabolic syndrome and a prolonged QT interval, so caution is necessary. The other choices do not pertain to the side effects of antipsychotics.
Antipsychotics are a type of medication used to treat schizophrenia, psychosis, mania, and agitation. They are divided into two categories: typical and atypical antipsychotics. The latter were developed to address the extrapyramidal side-effects associated with the first generation of typical antipsychotics. Typical antipsychotics work by blocking dopaminergic transmission in the mesolimbic pathways through dopamine D2 receptor antagonism. However, they are known to cause extrapyramidal side-effects such as Parkinsonism, acute dystonia, akathisia, and tardive dyskinesia. These side-effects can be managed with procyclidine. Other side-effects of typical antipsychotics include antimuscarinic effects, sedation, weight gain, raised prolactin, impaired glucose tolerance, neuroleptic malignant syndrome, reduced seizure threshold, and prolonged QT interval. The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients due to an increased risk of stroke and venous thromboembolism.
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This question is part of the following fields:
- Psychiatry
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Question 4
Incorrect
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What type of hallucination is Lillian experiencing while being unwell in bed with pneumonia and seeing a tiny marching band on her bedclothes?
Your Answer: Visual hallucination - elementary hallucination
Correct Answer: Visual hallucination - Lilliputian hallucinations
Explanation:Types of Hallucinations
Hallucinations are false perceptions that occur simultaneously with real perceptions. There are different types of hallucinations, including visual hallucinations associated with micropsia, which are known as Lilliputian hallucinations. These hallucinations often occur in patients suffering from delirium. Another type of visual hallucination is elementary hallucinations, which appear as flashes of light.
Extracampine hallucinations occur when an individual experiences a hallucination outside their sensory field, such as seeing someone standing behind them while looking straight ahead. Reflex hallucinations happen when a true sensory stimulus causes a hallucination in another sensory modality. Lastly, autoscopy is the experience of seeing oneself and knowing it is oneself, also known as the phantom mirror-image. the different types of hallucinations can help in identifying and treating them appropriately.
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This question is part of the following fields:
- Psychiatry
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Question 5
Correct
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A woman punishes her 10-year-old son for breaking his younger sibling's toy by removing one of his favourite toys from the shelf. Her son becomes tearful and wets his bed. He was a previously toilet-trained child.
Which ego defence mechanism is demonstrated by the 10-year-old's behaviour of wetting his bed after being punished for breaking his sibling's toy?Your Answer: Regression
Explanation:Regression refers to the involuntary process of reverting back to earlier ways of dealing with the world, which is different from fixation. This phenomenon is commonly observed in children who are experiencing stress due to factors such as illness, punishment, or the arrival of a new sibling. For instance, a child who was previously toilet-trained may start bedwetting again under such circumstances. Other related psychological concepts include reaction formation, fixation, and displacement.
Understanding Ego Defenses
Ego defenses are psychological mechanisms that individuals use to protect themselves from unpleasant emotions or thoughts. These defenses are classified into four levels, each with its own set of defense mechanisms. The first level, psychotic defenses, is considered pathological as it distorts reality to avoid dealing with it. The second level, immature defenses, includes projection, acting out, and projective identification. The third level, neurotic defenses, has short-term benefits but can lead to problems in the long run. These defenses include repression, rationalization, and regression. The fourth and most advanced level, mature defenses, includes altruism, sublimation, and humor.
Despite the usefulness of understanding ego defenses, their classification and definitions can be inconsistent and frustrating to learn for exams. It is important to note that these defenses are not necessarily good or bad, but rather a natural part of human behavior. By recognizing and understanding our own ego defenses, we can better manage our emotions and thoughts in a healthy way.
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This question is part of the following fields:
- Psychiatry
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Question 6
Correct
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A young intern consistently shows up late for rounds and fabricates medical excuses. Meanwhile, they criticize a fellow intern for being unreliable and inept in their duties.
Which ego defense mechanism is being exhibited in this scenario?Your Answer: Projection
Explanation:Understanding Ego Defenses
Ego defenses are psychological mechanisms that individuals use to protect themselves from unpleasant emotions or thoughts. These defenses are classified into four levels, each with its own set of defense mechanisms. The first level, psychotic defenses, is considered pathological as it distorts reality to avoid dealing with it. The second level, immature defenses, includes projection, acting out, and projective identification. The third level, neurotic defenses, has short-term benefits but can lead to problems in the long run. These defenses include repression, rationalization, and regression. The fourth and most advanced level, mature defenses, includes altruism, sublimation, and humor.
Despite the usefulness of understanding ego defenses, their classification and definitions can be inconsistent and frustrating to learn for exams. It is important to note that these defenses are not necessarily good or bad, but rather a natural part of human behavior. By recognizing and understanding our own ego defenses, we can better manage our emotions and thoughts in a healthy way.
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This question is part of the following fields:
- Psychiatry
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Question 7
Incorrect
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A 35-year-old male patient is feeling impatient as he waits in a crowded Emergency Room (ER) waiting area. He snaps at his daughter in annoyance.
What ego defence mechanism is he utilizing?Your Answer: Reaction formation
Correct Answer: Displacement
Explanation:Understanding Ego Defenses
Ego defenses are psychological mechanisms that individuals use to protect themselves from unpleasant emotions or thoughts. These defenses are classified into four levels, each with its own set of defense mechanisms. The first level, psychotic defenses, is considered pathological as it distorts reality to avoid dealing with it. The second level, immature defenses, includes projection, acting out, and projective identification. The third level, neurotic defenses, has short-term benefits but can lead to problems in the long run. These defenses include repression, rationalization, and regression. The fourth and most advanced level, mature defenses, includes altruism, sublimation, and humor.
Despite the usefulness of understanding ego defenses, their classification and definitions can be inconsistent and frustrating to learn for exams. It is important to note that these defenses are not necessarily good or bad, but rather a natural part of human behavior. By recognizing and understanding our own ego defenses, we can better manage our emotions and thoughts in a healthy way.
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This question is part of the following fields:
- Psychiatry
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Question 8
Correct
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A teenage boy is brought to the emergency department by his family after stating that his 'insides' have ceased functioning and that he is to blame for the Syrian refugee crisis. Upon examination, the physician observes that he appears depressed and speaks in a slow, monotone voice with minimal facial expressions. What is the probable diagnosis?
Your Answer: Psychotic depression
Explanation:These delusions are congruent with depression in terms of mood, as they are considered to be depressing delusions.
Screening and Assessment of Depression
Depression is a common mental health condition that affects many people worldwide. Screening and assessment are important steps in identifying and managing depression. The screening process involves asking two simple questions to determine if a person is experiencing symptoms of depression. If the answer is yes to either question, a more in-depth assessment is necessary.
Assessment tools such as the Hospital Anxiety and Depression (HAD) scale and the Patient Health Questionnaire (PHQ-9) are commonly used to assess the severity of depression. The HAD scale consists of 14 questions, seven for anxiety and seven for depression. Each item is scored from 0-3, producing a score out of 21 for both anxiety and depression. The PHQ-9 asks patients about nine different problems they may have experienced in the last two weeks, which can then be scored from 0-3. This tool also includes questions about thoughts of self-harm.
The DSM-IV criteria are used by NICE to grade depression. This criteria includes nine different symptoms, such as depressed mood, diminished interest or pleasure in activities, and feelings of worthlessness or guilt. The severity of depression can range from subthreshold depressive symptoms to severe depression with or without psychotic symptoms.
In conclusion, screening and assessment are crucial steps in identifying and managing depression. By using tools such as the HAD scale and PHQ-9, healthcare professionals can accurately assess the severity of depression and provide appropriate treatment.
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This question is part of the following fields:
- Psychiatry
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Question 9
Incorrect
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A 32-year-old patient with schizophrenia visits the clinic. He has observed discharge on his shirt twice and upon inspection, he noticed a milky fluid coming from his nipples. He recalls his psychiatrist mentioning that this could happen with his medication. What is the most probable reason for his discharge?
Your Answer: Olanzapine
Correct Answer: Risperidone
Explanation:Hyperprolactinaemia, which is characterized by high levels of prolactin, is a common side effect of certain atypical antipsychotics like risperidone. This medication can cause galactorrhoea, which is the abnormal secretion of milk due to the development of breast tissue and mammary glands.
Different antipsychotics have their own unique side effect profiles, and the most likely culprits of hyperprolactinaemia are haloperidol (a conventional antipsychotic) and risperidone (an atypical antipsychotic). While it is uncommon for most atypical antipsychotics to cause galactorrhoea, risperidone is an exception.
Other antipsychotics like clozapine are associated with agranulocytosis and myocarditis, while olanzapine is linked to dyslipidaemia, diabetes mellitus, and weight gain.
Atypical antipsychotics are now recommended as the first-line treatment for patients with schizophrenia, as per the 2005 NICE guidelines. These agents have a significant advantage over traditional antipsychotics in that they cause fewer extrapyramidal side-effects. However, atypical antipsychotics can still cause adverse effects such as weight gain, hyperprolactinaemia, and clozapine-associated agranulocytosis. Elderly patients who take antipsychotics are at an increased risk of stroke and venous thromboembolism, according to the Medicines and Healthcare products Regulatory Agency.
Clozapine is one of the first atypical antipsychotics to be developed, but it carries a significant risk of agranulocytosis. Therefore, full blood count monitoring is essential during treatment. Clozapine should only be used in patients who are resistant to other antipsychotic medication. The BNF recommends introducing clozapine if schizophrenia is not controlled despite the sequential use of two or more antipsychotic drugs, one of which should be a second-generation antipsychotic drug, each for at least 6-8 weeks. Clozapine can cause adverse effects such as reduced seizure threshold, constipation, myocarditis, and hypersalivation. Dose adjustment of clozapine may be necessary if smoking is started or stopped during treatment.
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This question is part of the following fields:
- Psychiatry
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Question 10
Correct
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A 9-year-old boy has started attending a different school after his family moved to a new town. His teacher is worried because he never talks in class. However, his parents have noticed that he talks to his cousins on video calls when he's alone in his room. What could be the reason for this boy's communication struggles?
Your Answer: Selective mutism
Explanation:Selective Mutism and Other Speech Disorders
Selective mutism is a condition where a person is unable to speak in certain situations, such as public places or specific classes in school. However, they can speak normally when they feel they are not being observed, such as at home. This condition is often seen in children.
Other speech disorders are also present in psychotic and organic disorders. Alogia is a negative symptom of schizophrenia, characterized by a poverty of speech. Bradyphasia is a condition where a person speaks slowly. Echolalia is the repetition of parts of others’ speech, while paraphasia is the mispronunciation of single words or the combination of words in inappropriate or meaningless ways.
It is important to understand these speech disorders to provide appropriate treatment and support for those affected. By recognizing the symptoms and seeking professional help, individuals with these conditions can improve their communication skills and overall quality of life.
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This question is part of the following fields:
- Psychiatry
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Question 11
Correct
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A 25-year-old woman comes to the clinic after attempting suicide. The physician suspects an underlying psychiatric condition and conducts a screening for psychiatric symptoms. During the screening, the patient reports experiencing symptoms for the past two years, such as feeling low, fatigue, and loss of interest in her hobbies. Based on this, the doctor diagnoses her with major depressive disorder. What clinical feature would warrant a reevaluation of her diagnosis?
Your Answer: Persecutory delusions
Explanation:Schizophrenia can be indicated by the presence of persecutory delusions, while the symptoms of depression align with the diagnosis. Guilty delusions, specifically, are a symptom commonly seen in cases of psychotic depression.
Screening and Assessment of Depression
Depression is a common mental health condition that affects many people worldwide. Screening and assessment are important steps in identifying and managing depression. The screening process involves asking two simple questions to determine if a person is experiencing symptoms of depression. If the answer is yes to either question, a more in-depth assessment is necessary.
Assessment tools such as the Hospital Anxiety and Depression (HAD) scale and the Patient Health Questionnaire (PHQ-9) are commonly used to assess the severity of depression. The HAD scale consists of 14 questions, seven for anxiety and seven for depression. Each item is scored from 0-3, producing a score out of 21 for both anxiety and depression. The PHQ-9 asks patients about nine different problems they may have experienced in the last two weeks, which can then be scored from 0-3. This tool also includes questions about thoughts of self-harm.
The DSM-IV criteria are used by NICE to grade depression. This criteria includes nine different symptoms, such as depressed mood, diminished interest or pleasure in activities, and feelings of worthlessness or guilt. The severity of depression can range from subthreshold depressive symptoms to severe depression with or without psychotic symptoms.
In conclusion, screening and assessment are crucial steps in identifying and managing depression. By using tools such as the HAD scale and PHQ-9, healthcare professionals can accurately assess the severity of depression and provide appropriate treatment.
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This question is part of the following fields:
- Psychiatry
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Question 12
Correct
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A 26-year-old woman has recently begun her career as a graphic designer. Her partner has observed that she spends extensive amounts of time working on what she believes will be the most innovative design project ever created that will transform the industry. Despite acknowledging that she may not succeed, she remains highly motivated. How would you describe her thought process?
Your Answer: Overvalued idea
Explanation:Overvalued Ideas
An overvalued idea is a comprehensible and acceptable belief that dominates a person’s life and preoccupies their mind. It is not a delusion, and the person acknowledges the possibility that their belief may or may not be true. However, they pursue their aim with an overwhelming desire. Despite the intensity of their belief, the person remains functioning, and there is no evidence of psychotic symptoms.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), an overvalued idea is an unreasonable and sustained belief that is maintained with less than delusional intensity. This means that the person is aware that their belief may not be accepted by others in their culture or subculture.
In summary, an overvalued idea is a strong belief that is not firmly fixed as true, but still dominates a person’s life. It is not a delusion, and the person remains functioning. overvalued ideas is important in distinguishing them from delusions and other mental health conditions.
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This question is part of the following fields:
- Psychiatry
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Question 13
Correct
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What is the name of the illusion that occurs when Fred sees a face in the clouds while walking his dog in the park?
Your Answer: Pareidolia
Explanation:Types of Illusions and Their Characteristics
Illusions are vivid perceptions that occur from unclear stimuli. They can happen without conscious effort and are often intensified with concentration. There are three broad types of illusions: completion, affect, and pareidolia. Completion illusions occur due to inattention when reading, such as misreading words or completing faded letters. Affect illusions are associated with specific mood states, where someone may ‘see’ their loved one who has recently passed away. Pareidolia occurs when an individual perceives a clear image in an otherwise vague stimulus, such as seeing faces or animals in clouds.
Auditory illusions can also occur when someone overhears a conversation and ‘completes’ overheard phrases or words, often in a way that makes it appear that they are being discussed. Trailing phenomena are associated with hallucinogenic drugs and are changes in perception where an individual perceives a moving object as a series of discontinuous images. Overall, illusions can occur in any sensory modality, but the most commonly reported are visual. They are not related to affect or state of mind, but rather a result of fantasy and vivid visual imagery.
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This question is part of the following fields:
- Psychiatry
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Question 14
Correct
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As a new resident on the medical assessment unit, you are attending a consultant-led ward round. A 45-year-old male with a history of alcohol-related liver failure becomes agitated and threatens to punch the consultant. He displays coarse tremors in both hands and appears highly anxious.
The patient is a chronic alcoholic.
What is the preferred medication for managing his symptoms?Your Answer: Lorazepam
Explanation:To prevent increased sedation, lorazepam is the preferred medication for alcohol withdrawal syndrome in patients with hepatic failure, rather than chlordiazepoxide. Naloxone is used for opioid overdose and respiratory depression caused by opioids, while flumazenil is not used for alcohol withdrawal management as it counteracts the effects of benzodiazepines.
Alcohol withdrawal occurs when an individual who has been consuming alcohol chronically suddenly stops or reduces their intake. This is due to the fact that chronic alcohol consumption enhances GABA-mediated inhibition in the central nervous system (CNS), similar to benzodiazepines, and inhibits NMDA-type glutamate receptors. When alcohol consumption is stopped, the opposite occurs, resulting in decreased inhibitory GABA and increased NMDA glutamate transmission.
Symptoms of alcohol withdrawal typically start within 6-12 hours and include tremors, sweating, tachycardia, and anxiety. Seizures are most likely to occur at around 36 hours, while delirium tremens, which is characterized by coarse tremors, confusion, delusions, auditory and visual hallucinations, fever, and tachycardia, is most likely to occur at around 48-72 hours.
Patients with a history of complex withdrawals from alcohol, such as delirium tremens, seizures, or blackouts, should be admitted to the hospital for monitoring until their withdrawals stabilize. The first-line treatment for alcohol withdrawal is long-acting benzodiazepines, such as chlordiazepoxide or diazepam, which are typically given as part of a reducing dose protocol. Lorazepam may be preferable in patients with hepatic failure. Carbamazepine is also effective in treating alcohol withdrawal, while phenytoin is said not to be as effective in the treatment of alcohol withdrawal seizures.
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This question is part of the following fields:
- Psychiatry
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Question 15
Incorrect
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A 78-year-old male is admitted to your ward with community-acquired pneumonia. He has a history of Parkinson's disease for the past 6 years. The patient becomes increasingly agitated during his stay, and you notice that he is prescribed haloperidol for agitation. However, after receiving the medication, his Parkinson's symptoms worsen significantly. What is the likely mechanism of action of haloperidol?
Your Answer: Decreased dopamine stores
Correct Answer: Blocks dopamine receptors
Explanation:Haloperidol is a typical antipsychotic that works by blocking dopamine receptors in the brain. However, typical antipsychotics are known to have non-selective blockage of various dopamine receptors, leading to unwanted side effects such as parkinsonism. This is particularly problematic for individuals with Parkinson’s disease, as the depletion of dopaminergic neurons already present in the condition can be further exacerbated by the use of antipsychotics that block any remaining dopamine transmissions.
Antipsychotics are a type of medication used to treat schizophrenia, psychosis, mania, and agitation. They are divided into two categories: typical and atypical antipsychotics. The latter were developed to address the extrapyramidal side-effects associated with the first generation of typical antipsychotics. Typical antipsychotics work by blocking dopaminergic transmission in the mesolimbic pathways through dopamine D2 receptor antagonism. However, they are known to cause extrapyramidal side-effects such as Parkinsonism, acute dystonia, akathisia, and tardive dyskinesia. These side-effects can be managed with procyclidine. Other side-effects of typical antipsychotics include antimuscarinic effects, sedation, weight gain, raised prolactin, impaired glucose tolerance, neuroleptic malignant syndrome, reduced seizure threshold, and prolonged QT interval. The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients due to an increased risk of stroke and venous thromboembolism.
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This question is part of the following fields:
- Psychiatry
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Question 16
Correct
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A 38-year-old male with a history of alcohol abuse is under the care of a nursing home due to a diagnosis of Wernicke's encephalopathy. What vitamin deficiency is the cause of this condition?
Your Answer: Thiamine
Explanation:Wernicke’s Encephalopathy
Wernicke’s encephalopathy is a condition that is linked to bleeding in the mamillary bodies of the brain. This condition is commonly seen in patients who have a deficiency in thiamine. The symptoms of Wernicke’s encephalopathy include an altered mental state, difficulty with coordination and balance, and ophthalmoplegia. This condition is particularly problematic for individuals who abuse alcohol as they often rely on alcohol for their daily caloric intake.
Wernicke’s encephalopathy is a serious condition that can have long-lasting effects on a person’s health. With proper treatment and care, it is possible to manage the symptoms of Wernicke’s encephalopathy and improve overall health and well-being.
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This question is part of the following fields:
- Psychiatry
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Question 17
Incorrect
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A middle-aged male patient with a history of schizophrenia and non-compliance with medication presents with delusions of alien possession. How would you characterize his delusions?
Your Answer: Nihilistic delusions
Correct Answer: Delusions of control
Explanation:Schizophrenia Symptoms: Delusion of Control, Depersonalisation, and Delusions of Misidentification
Delusion of control, also known as passivity experience, is a primary symptom of schizophrenia identified by Schneider. This symptom is characterized by the belief that one’s body, mind, volition, or emotion is being controlled by another entity, being, or force. On the other hand, depersonalisation is the feeling of being disconnected from reality, often accompanied by derealisation.
Delusions of misidentification, another symptom of schizophrenia, can be divided into two types: Fregoli Syndrome and Capgras Syndrome. Fregoli Syndrome is the belief that someone whose appearance is unfamiliar is actually someone you know, while Capgras Syndrome is the belief that someone who looks familiar is an imposter.
Overall, these symptoms can significantly impact an individual’s perception of reality and their ability to function in daily life. It is important to seek professional help if experiencing any of these symptoms or suspecting someone else may be experiencing them.
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This question is part of the following fields:
- Psychiatry
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Question 18
Incorrect
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A 45-year-old man is undergoing psychiatric assessment for presenting symptoms of low mood, lack of interest, fatigue, and suicidal ideation. He has been unemployed for a year and divorced his wife. He is facing financial difficulties and has been heavily drinking alcohol for the past few years. He attempted suicide three years ago.
What is the primary risk factor for future suicide completion in this patient?Your Answer: Male gender
Correct Answer: Previous suicide attempt
Explanation:One of the most significant risk factors for future suicide completion is a history of previous suicide attempts, even when other risk factors such as male sex, young or elderly age, depression, alcohol or drug use, lack of social support, and expressed future intent are present.
The risk of suicide in psychiatric patients is often stratified into high, medium, or low risk categories, but there is limited evidence on the positive predictive value of individual risk factors. A review in the BMJ concluded that these assessments may not be useful in guiding decision making, as 50% of suicides occur in patients deemed low risk. However, certain factors have been associated with an increased risk of suicide, such as male sex, history of deliberate self-harm, alcohol or drug misuse, mental illness, depression, schizophrenia, chronic disease, advancing age, unemployment or social isolation, and being unmarried, divorced, or widowed.
If a patient has attempted suicide, there are additional factors that increase the risk of completed suicide in the future, such as efforts to avoid discovery, planning, leaving a written note, final acts such as sorting out finances, and using a violent method. On the other hand, there are protective factors that can reduce the risk of suicide, such as having family support, having children at home, and having a religious belief.
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This question is part of the following fields:
- Psychiatry
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Question 19
Incorrect
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Samantha is undergoing an evaluation with the psychologist. Her sister has joined the session to provide her with moral support. With Samantha's consent, the psychologist is inquiring her sister about her personality.
Samantha's sister characterizes her to the psychologist as someone who appears to be lively, charming and sociable at first. However, as you spend more time with her, you come to realize that she is excessively theatrical, constantly seeking attention and admiration, and she can be quite manipulative.
What kind of personality disorder does Samantha have?Your Answer: Emotionally unstable - borderline personality disorder
Correct Answer: Histrionic personality disorder
Explanation:Personality Disorders: General Criteria and Specific Types
Personality disorders are a group of mental health conditions that are characterised by deviations from the cultural norm in cognition, affect, impulse control, or relating to others. According to ICD-10, individuals diagnosed with a personality disorder must meet certain general criteria, including long-term evidence of the deviation since childhood or adolescence, distress to the individual or negative impact on their social environment, and the absence of an alternative mental disorder or organic brain injury.
There are several specific types of personality disorders, each with their own unique characteristics. Histrionic personality disorder is characterised by self-dramatisation, suggestibility, shallow affectivity, and a continual seeking for excitement and attention. Borderline personality disorder is associated with disturbances in self-image, intense relationships, emotional crises, and deliberate self-harm. Anankastic personality disorder is similar to obsessive-compulsive personality disorder, with individuals becoming preoccupied with detail, rules, and schedules to the point of hindering completion of tasks and relationships. Schizoid personality disorder is characterised by emotional detachment and solitary activities, while paranoid personality disorder involves high levels of suspicion and distrust towards others.
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This question is part of the following fields:
- Psychiatry
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Question 20
Incorrect
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A nursing student is concerned after hearing a voice calling her name while drifting off to sleep. She has no history of hearing voices and denies any symptoms of psychosis. There is no evidence of substance abuse or alcohol misuse.
What is the probable diagnosis for her encounter?Your Answer: Pseudo-hallucination
Correct Answer: Hypnagogic hallucination
Explanation:Hypnagogic and Hypnopompic Hallucinations
Hypnagogic and hypnopompic hallucinations are common experiences that have been known since ancient times. Hypnagogic hallucinations occur when falling asleep, while hypnopompic hallucinations occur when waking up in the morning and falling asleep again. These hallucinations are mostly auditory in nature, with individuals typically hearing their name being called. However, they can also occur in other modalities such as vision, smell, and touch.
It is important to note that hypnagogic and hypnopompic hallucinations differ from illusions and elementary hallucinations. An illusion is the misperception of an actual stimulus, while an elementary hallucination is a simple noise such as knocking or tapping. On the other hand, a functional hallucination is triggered by a stimulus in the same modality. For example, hearing a doorbell may cause the individual to hear a voice.
the different types of hallucinations can help individuals recognize and cope with their experiences. It is also important to seek medical attention if these hallucinations become frequent or interfere with daily life. By these phenomena, individuals can better navigate their experiences and seek appropriate treatment if necessary.
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This question is part of the following fields:
- Psychiatry
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Question 21
Correct
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John is a 26-year-old male with schizophrenia who is undergoing treatment. Which antipsychotic medication is most likely to cause parkinsonism, sustained muscle contractions, and severe restlessness as side effects?
Your Answer: Haloperidol
Explanation:Typical antipsychotics are more likely to cause extrapyramidal side-effects (EPSEs) than atypical antipsychotics. Haloperidol is the only typical antipsychotic among the given options, while aripiprazole, olanzapine, quetiapine, and risperidone are all atypical antipsychotics. EPSEs include Parkinsonism, akathisia, acute dystonia, and tardive dyskinesia. Atypical antipsychotics have a lower risk of causing EPSEs than older antipsychotics, but they may still cause them at higher doses. However, atypical antipsychotics carry a higher risk of metabolic side effects such as weight gain, diabetes mellitus, and hyperlipidaemia. Examples of typical antipsychotics licensed for use in the UK include haloperidol, trifluperazine, chlorpromazine, pericyazine, levomepromazine, and flupentixol. Examples of atypical antipsychotics licensed for use in the UK include amisulpride, aripiprazole, clozapine, lurasidone, olanzapine, paliperidone, and quetiapine.
Antipsychotics are a type of medication used to treat schizophrenia, psychosis, mania, and agitation. They are divided into two categories: typical and atypical antipsychotics. The latter were developed to address the extrapyramidal side-effects associated with the first generation of typical antipsychotics. Typical antipsychotics work by blocking dopaminergic transmission in the mesolimbic pathways through dopamine D2 receptor antagonism. However, they are known to cause extrapyramidal side-effects such as Parkinsonism, acute dystonia, akathisia, and tardive dyskinesia. These side-effects can be managed with procyclidine. Other side-effects of typical antipsychotics include antimuscarinic effects, sedation, weight gain, raised prolactin, impaired glucose tolerance, neuroleptic malignant syndrome, reduced seizure threshold, and prolonged QT interval. The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients due to an increased risk of stroke and venous thromboembolism.
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This question is part of the following fields:
- Psychiatry
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Question 22
Correct
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A 23-year-old woman visits the clinic after discovering that her partner has been involved in another relationship. She expresses intense anger and reports struggling to concentrate on her upcoming college classes and track competition. She also shares that she is using her anger to fuel her training for the track meet.
What defense mechanism is she displaying?Your Answer: Sublimation
Explanation:Understanding Ego Defenses
Ego defenses are psychological mechanisms that individuals use to protect themselves from unpleasant emotions or thoughts. These defenses are classified into four levels, each with its own set of defense mechanisms. The first level, psychotic defenses, is considered pathological as it distorts reality to avoid dealing with it. The second level, immature defenses, includes projection, acting out, and projective identification. The third level, neurotic defenses, has short-term benefits but can lead to problems in the long run. These defenses include repression, rationalization, and regression. The fourth and most advanced level, mature defenses, includes altruism, sublimation, and humor.
Despite the usefulness of understanding ego defenses, their classification and definitions can be inconsistent and frustrating to learn for exams. It is important to note that these defenses are not necessarily good or bad, but rather a natural part of human behavior. By recognizing and understanding our own ego defenses, we can better manage our emotions and thoughts in a healthy way.
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This question is part of the following fields:
- Psychiatry
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Question 23
Incorrect
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Sophie is at a crowded concert. She is standing near a group of her favorite band's fans and she can hear part of their conversation. She thinks she hears the name of her favorite band member mentioned.
What kind of illusion is Sophie experiencing?Your Answer: Affect illusion
Correct Answer: Auditory illusion
Explanation:Types of Illusions and Examples
Illusions can occur in any sensory modality, but the most commonly reported are visual. However, there are three broad types of illusions: affect illusion, completion illusion, and pareidolia. Affect illusion is associated with specific mood states, such as someone who has recently been bereaved may ‘see’ their loved one. Completion illusion is due to inattention when reading, such as misreading words or completing faded letters. Pareidolia occurs when an individual perceives a vivid picture in an otherwise vague or obscure stimulus, such as seeing faces or animals in clouds.
Fantastic illusions were described by some of the classic psychiatrists. For example, Fish described a patient who, during an interview, stated that the psychiatrist’s head changed to a rabbit’s head. This patient was known to confabulate and exaggerate. Another example of an auditory illusion is when a partially overheard conversation is misrepresented or misinterpreted by the listener, leading them to believe that they are being discussed.
In conclusion, illusions can occur in various forms and can be caused by different factors. It is important to understand the different types of illusions to avoid misinterpretation and confusion.
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This question is part of the following fields:
- Psychiatry
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Question 24
Incorrect
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A 27-year-old individual diagnosed with schizophrenia has a history of cannabis misuse and has discontinued their medication. They are currently experiencing auditory hallucinations where multiple voices are conversing about them. The voices are making derogatory comments, accusing the individual of being a paedophile and deserving punishment.
What is the best description of this hallucination?Your Answer: Second person hallucination
Correct Answer: Third person hallucination
Explanation:Types of Auditory Hallucinations
There are different types of auditory hallucinations that individuals may experience. One type is third person hallucinations, where patients hear voices talking about them in the third person. This is considered a first rank symptom of schizophrenia, but it can also occur in other psychiatric disorders such as mania. Another type is extra-campine hallucinations, which are perceived as coming from outside of the normal sensory field, such as from several miles away. Functional hallucinations, on the other hand, are triggered by stimuli within the same sensory field, such as hearing a phone ring that triggers a voice. Lastly, imperative hallucinations involve the auditory hallucination giving instructions to the patient.
the Different Types of Auditory Hallucinations
Auditory hallucinations can be a distressing experience for individuals who hear voices that are not there. It is important to note that there are different types of auditory hallucinations, each with their own unique characteristics. Third person hallucinations involve hearing voices talking about the individual in the third person, while extra-campine hallucinations are perceived as coming from outside of the normal sensory field. Functional hallucinations are triggered by stimuli within the same sensory field, and imperative hallucinations involve the auditory hallucination giving instructions to the patient. the different types of auditory hallucinations can help individuals and healthcare professionals better identify and manage these experiences.
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This question is part of the following fields:
- Psychiatry
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Question 25
Incorrect
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As a medical student in general practice, a 37-year-old male with chronic back pain comes in for a refill of his amitriptyline prescription. Can you explain the mechanism of action of this medication?
Your Answer: Antagonist on monoamine receptors on postsynaptic membrane
Correct Answer: Inhibits monoamine reuptake on the presynaptic membrane
Explanation:Amitriptyline belongs to the class of tricyclic antidepressants (TCAs).
TCAs primarily act on the presynaptic neuron rather than the postsynaptic neuron. Their main mode of action involves inhibiting the reuptake of monoamines at the presynaptic membrane. This is achieved by binding to the ATPase monoamine pump located within the presynaptic membrane.
Tricyclic antidepressants (TCAs) are not commonly used for depression anymore due to their side-effects and potential for toxicity in overdose. However, they are still widely used for the treatment of neuropathic pain, where smaller doses are typically required. The common side-effects of TCAs include drowsiness, dry mouth, blurred vision, constipation, urinary retention, and lengthening of QT interval. When choosing a TCA, low-dose amitriptyline is commonly used for the management of neuropathic pain and the prevention of headaches. Lofepramine is preferred due to its lower incidence of toxicity in overdose, while amitriptyline and dosulepin are considered the most dangerous in overdose. The sedative effects of TCAs vary, with amitriptyline, clomipramine, dosulepin, and trazodone being more sedative, while imipramine and nortriptyline are less sedative. Trazodone is technically a ‘tricyclic-related antidepressant’.
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This question is part of the following fields:
- Psychiatry
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Question 26
Incorrect
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A 20-year-old male student is seeking treatment for his anxiety disorder at a mental health clinic. The psychiatrist discovers a record of sexual assault that occurred 8 months ago. When asked about the incident, the student cannot remember the details.
What ego defence mechanism is being exhibited in this scenario?Your Answer: Suppression
Correct Answer: Repression
Explanation:Understanding Ego Defenses
Ego defenses are psychological mechanisms that individuals use to protect themselves from unpleasant emotions or thoughts. These defenses are classified into four levels, each with its own set of defense mechanisms. The first level, psychotic defenses, is considered pathological as it distorts reality to avoid dealing with it. The second level, immature defenses, includes projection, acting out, and projective identification. The third level, neurotic defenses, has short-term benefits but can lead to problems in the long run. These defenses include repression, rationalization, and regression. The fourth and most advanced level, mature defenses, includes altruism, sublimation, and humor.
Despite the usefulness of understanding ego defenses, their classification and definitions can be inconsistent and frustrating to learn for exams. It is important to note that these defenses are not necessarily good or bad, but rather a natural part of human behavior. By recognizing and understanding our own ego defenses, we can better manage our emotions and thoughts in a healthy way.
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This question is part of the following fields:
- Psychiatry
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Question 27
Incorrect
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What are the personality disorders included in Cluster B (the 'dramatic' group) in the DSM?
Your Answer: Avoidant, dependant, and obsessive-compulsive
Correct Answer: Antisocial, borderline, histrionic, and narcissistic
Explanation:Classification of Psychiatric Disorders
Psychiatric disorders are often grouped together based on their similarities, which can be useful for research and classification purposes. The three main clusters are eccentric, dramatic, and fearful. The eccentric cluster includes paranoid, schizoid, and schizotypal disorders. The dramatic cluster includes borderline, narcissistic, antisocial, and histrionic disorders. The fearful cluster includes obsessive-compulsive, avoidant, and dependent disorders.
The classification of psychiatric disorders follows the operational criteria of either DSM or ICD. DSM-V, published by the American Psychiatric Association, is multi-axial and allows for assessment of the patient’s current mental state diagnosis, personality disorder and learning difficulties, any physical condition, psychosocial or environmental factors, and global assessment of functioning scale. On the other hand, ICD-10, published by the World Health Organization, is used widely in Europe and also includes a multi-axial approach. However, personality disorder is not differentiated from other mental state disorders in ICD. The three axes in ICD are current mental state diagnosis (including personality disorder), disabilities, and contextual factors.
In summary, the classification of psychiatric disorders is important for research and treatment purposes. The three main clusters of disorders are eccentric, dramatic, and fearful. DSM and ICD are the two main operational criteria used for classification, with DSM being multi-axial and including a global assessment of functioning scale, while ICD is also multi-axial but does not differentiate personality disorder from other mental state disorders.
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This question is part of the following fields:
- Psychiatry
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Question 28
Incorrect
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A 16-year-old girl is brought to her family doctor by her parents due to concerns about her weight and low mood. The parents are worried that their daughter has been excessively focused on her weight and has lost interest in her hobbies. The girl admits to exercising and watching her weight, but also reports feeling low for the past month and having trouble sleeping. The doctor measures her body mass index at 17.8 kg per m² and suggests prescribing an antidepressant to improve her mood. However, which of the following antidepressants is specifically contraindicated in this patient?
Your Answer: Fluoxetine
Correct Answer: Bupropion
Explanation:The young girl in question appears to be suffering from anorexia nervosa, as she is overly concerned with her weight despite having a low body mass index. It is common for females of a young age to develop this condition, and it is often accompanied by depression, which can manifest as low mood, loss of interest in hobbies, and sleep disturbances.
One recommended antidepressant for patients with anorexia nervosa is mirtazapine, as it can also increase appetite and promote weight gain. Fluoxetine, a selective serotonin reuptake inhibitor, is not contraindicated for anorexia nervosa, but it can cause gastrointestinal distress or sexual dysfunction, which may make it difficult for young patients to comply with the medication. Amitriptyline, a tricyclic antidepressant, is typically used for major depression but has a worse side-effect profile than selective serotonin reuptake inhibitors. Bupropion, an atypical antidepressant commonly used for smoking cessation, is not recommended for patients with anorexia nervosa or bulimia nervosa, as it can lower the seizure threshold and increase the risk of seizures.
Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for depression, with citalopram and fluoxetine being the preferred options. They should be used with caution in children and adolescents, and patients should be monitored for increased anxiety and agitation. Gastrointestinal symptoms are the most common side-effect, and there is an increased risk of gastrointestinal bleeding. Citalopram and escitalopram are associated with dose-dependent QT interval prolongation and should not be used in certain patients. SSRIs have a higher propensity for drug interactions, and patients should be reviewed after 2 weeks of treatment. When stopping a SSRI, the dose should be gradually reduced over a 4 week period. Use of SSRIs during pregnancy should be weighed against the risks and benefits.
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This question is part of the following fields:
- Psychiatry
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Question 29
Incorrect
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A 52-year-old woman visited her family doctor with a complaint of long-standing abdominal discomfort. She describes the discomfort as diffuse and feels a heavy dragging sensation in her abdomen. Upon further inquiry, she reveals that she has been experiencing this abdominal discomfort for a few years. Her medical records indicate that she has undergone various investigations, including imaging studies and upper gastrointestinal endoscopy, but none of them revealed any significant findings. Recently, her CA-125 levels were found to be normal. The woman has a history of mild depression and takes citalopram. She also reports experiencing bodily pain in multiple locations. Physical examination does not reveal any abnormalities. What is the most likely diagnosis for this woman?
Your Answer: Munchausen syndrome
Correct Answer: Somatic symptom disorder
Explanation:The patient’s symptoms were indicative of a psychiatric condition associated with somatic symptom disorders, rather than a manifestation of hypochondria or cancer.
Unexplained Symptoms in Psychiatry
In psychiatry, there are several terms used to describe patients who present with physical or psychological symptoms for which no organic cause can be found. Somatisation disorder is characterized by the presence of multiple physical symptoms that persist for at least two years, and the patient refuses to accept reassurance or negative test results. Illness anxiety disorder, also known as hypochondriasis, involves a persistent belief in the presence of an underlying serious disease, such as cancer, despite negative test results. Conversion disorder typically involves the loss of motor or sensory function, and the patient does not consciously feign the symptoms or seek material gain. Dissociative disorder involves the process of separating off certain memories from normal consciousness, and may present with psychiatric symptoms such as amnesia, fugue, or stupor. Factitious disorder, also known as Munchausen’s syndrome, involves the intentional production of physical or psychological symptoms, while malingering refers to the fraudulent simulation or exaggeration of symptoms for financial or other gain. These terms help clinicians to better understand and diagnose patients with unexplained symptoms.
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This question is part of the following fields:
- Psychiatry
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Question 30
Correct
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Samantha is a 60-year-old female who is well known to the emergency department due to regular admissions of intoxication and related incidents. The last time she was admitted was because of a fall after a drinking binge, it was later discovered that this was caused by visual impairment and balance issues. Before treatment could be initiated, she self-discharged.
This admission she was found roaming the streets with no clothes on, no idea of how she got there or who she was. Whilst in the department she would constantly ask where she was and when she could home, despite being told numerous times.
Which of the following would you expect to see in this patient?Your Answer: Confabulation
Explanation:Withdrawal from alcohol can lead to hallucinations, often in the form of visual images such as rats or bugs crawling on or around the patient.
Understanding Korsakoff’s Syndrome
Korsakoff’s syndrome is a memory disorder that is commonly observed in individuals who have a history of alcoholism. This condition is caused by a deficiency in thiamine, which leads to damage and haemorrhage in the mammillary bodies of the hypothalamus and the medial thalamus. Korsakoff’s syndrome often follows untreated Wernicke’s encephalopathy, which is another condition caused by thiamine deficiency.
The primary features of Korsakoff’s syndrome include anterograde amnesia, which is the inability to acquire new memories, and retrograde amnesia. Individuals with this condition may also experience confabulation, which is the production of fabricated or distorted memories to fill gaps in their recollection.
Understanding Korsakoff’s syndrome is crucial for individuals who have a history of alcoholism or thiamine deficiency. Early diagnosis and treatment can help prevent further damage and improve the individual’s quality of life. Proper nutrition and abstinence from alcohol are essential for managing this condition.
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This question is part of the following fields:
- Psychiatry
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