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Question 1
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A 36-year-old woman presents to her doctor and reports feeling anxious and self-conscious in social situations, particularly at work meetings where she worries that her colleagues view her as unintelligent of uninteresting. Despite no one ever expressing such opinions to her, she avoids social gatherings such as football games, pubs, and family events. She notes that this has been a lifelong issue, but has become more severe since starting her current job with frequent meetings. What is the probable diagnosis?
Your Answer: Social phobia
Explanation:An Overview of Anxiety Disorders
Anxiety disorders are a group of mental health conditions that are characterised by excessive and persistent feelings of fear, worry, and apprehension. There are several types of anxiety disorders, each with its own unique set of symptoms and diagnostic criteria.
Social phobia, also known as social anxiety disorder, is characterised by intermittent anxiety that is associated with specific social situations. Individuals with social phobia often feel the need to perform of fear being scrutinised in these situations, leading to avoidance as a maladaptive coping strategy.
Generalised anxiety disorder, on the other hand, is characterised by persistent free-floating anxiety that is not necessarily tied to any specific situation of trigger.
Paranoid personality disorder is not typically associated with anxiety as a key feature, although individuals with this condition may experience other symptoms such as suspiciousness and mistrust.
In contrast, paranoid schizophrenia may involve self-referential delusions, although the cognitive distortions seen in social phobia are not considered delusional.
Finally, specific phobia is a category of anxiety disorders that involves intense fear of anxiety in response to a specific object of situation, such as heights of spiders.
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- Diagnosis
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Question 2
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A 45-year-old man presents with a persistent abnormal movement of his neck. He experiences opisthotonos, retrocollis and mild blepharospasm, which worsen when walking of stressed and are not alleviated by alcohol. He has a history of paranoid schizophrenia for the past eight years and has been treated with various antipsychotics. Currently, he is stable on clozapine. What is the most probable diagnosis?
Your Answer: Tardive dystonia
Explanation:The symptoms described are consistent with tardive dystonia, which is commonly observed in younger patients who have been exposed to neuroleptic medication. Orofacial dyskinesia is more frequently seen in older patients. The symptoms do not suggest Huntington’s chorea of non-epileptic seizures, as the latter typically do not persist. Friedreich’s ataxia typically presents with muscle weakness and lack of coordination. Tourette’s syndrome is unlikely to cause such severe motor neurological symptoms.
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- Diagnosis
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Question 3
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You are asked to assist a middle-aged woman who is experiencing hyperventilation and finger spasms. She has had multiple similar episodes in the past few weeks, both at home and at work. What is the most probable diagnosis?
Your Answer: Panic disorder
Explanation:The symptoms described are consistent with panic disorder, as rapid hyperventilation and carpopedal spasm are common during panic attacks. Agoraphobia is not suggested as the episodes have occurred at home, ruling out the fear of leaving one’s safe space. Complex partial seizure is unlikely as there is no loss of consciousness. Generalized anxiety disorder is not a match as the anxiety is episodic. Social phobia is also unlikely as the symptoms do not align with this disorder.
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- Diagnosis
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Question 4
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In your clinic, a 25-year-old female patient presents with a frequent history of wrist cutting. Upon evaluation, you determine that she has a personality disorder. What specific type of personality disorder is the most probable diagnosis?
Your Answer: Borderline personality disorder
Explanation:Anankastic personality disorder is a personality disorder characterized by a preoccupation with orderliness, perfectionism, and control. It falls under cluster C personality disorders according to DSM-IV classification.
Deliberate self-harm is commonly associated with cluster B personality disorders. In the United Kingdom, poisoning by drugs accounts for 90% of deliberate self-harm cases, while wrist cutting accounts for 6-7%, and all other methods combined account for 3-4%. Frequent wrist cutting can be a part of recurrent suicidal gestures seen in individuals with depressive disorder, schizophrenia, and borderline personality disorder.
The reasons for wrist cutting are varied and complex, including a means of punishment oneself, reducing tension, feeling bodily instead of emotional pain, wishing to die, testing the benevolence of fate, seeking an interruption to an unendurable state of tension, crying for help, communicating with others, and unbearable symptoms.
Borderline personality disorder (BPD) is characterized by impulsive acts, mood instability, and chaotic relationships. Individuals with BPD are impulsive in areas that have a potential for self-harm and exhibit recurrent suicidal gestures such as wrist cutting, overdose, of self-mutilation.
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- Diagnosis
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Question 5
Incorrect
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A 25-year-old woman presents with unexplained weight loss and various medical tests have been inconclusive. You suspect she may be suffering from an eating disorder. Which of the following statements regarding anorexia nervosa and bulimia nervosa is accurate?
Your Answer: Patients with anorexia nervosa judge self-worth largely of exclusively in terms of shape and weight, but those with bulimia nervosa do not
Correct Answer: In anorexia nervosa body weight is significantly reduced, but in bulimia nervosa it is often normal
Explanation:Eating disorders are serious mental health conditions that can have severe physical consequences. Anorexia nervosa is diagnosed when a person has a BMI less than 17.5 kg/m2, self-induced weight loss, body image distortion, and abnormalities of the hypothalamic-pituitary-gonadal axis. On the other hand, bulimia nervosa is diagnosed when a person experiences recurrent episodes of binge eating and recurrent inappropriate compensatory behavior to prevent weight gain, occurring more than twice weekly for three months. Unlike anorexia nervosa, there is no diagnostic requirement for weight loss in bulimia nervosa. Both conditions are characterized by a preoccupation with shape and weight, and obtaining a reliable dietary history from the patient is unlikely. A key feature of bulimia nervosa is a feeling of loss of control during binge eating episodes.
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This question is part of the following fields:
- Diagnosis
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Question 6
Incorrect
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Which of the subsequent options is not classified as a personality disorder in the ICD-10?
Your Answer: Borderline
Correct Answer: Schizotypal
Explanation:While schizotypal personality disorder is included in the DSM, it is not listed as a separate diagnosis in the ICD-10. Instead, it is classified under the umbrella of schizophrenia. However, all of the other personality disorders mentioned are recognized in both the ICD-10 and DSM.
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This question is part of the following fields:
- Diagnosis
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Question 7
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A middle-aged man named John presents to the Emergency department with self-harm. The trigger for this was his wife asking him for a divorce.
John informs you that he could have been a successful businessman himself had he chosen and wants to know your exact income. He then asks to speak to your supervisor instead, and when you explain this is not possible, he refuses to continue the interview, saying that he is a financial expert and can be treated only by professionals.
His wife, who brought him in, explains that she can no longer cope with the patient's selfishness and lack of consideration. Things came to a head last night when she was upset and was crying. John stormed into her room to complain that the noise was keeping him awake. He then accused his wife of doing this purposively because she envied John's financial success. One of her friends went to college with John and says he has always been like this.
What is the most likely diagnosis?Your Answer: Narcissistic personality disorder
Explanation:Based on the collateral history provided, it is more likely that the individual is exhibiting a personality disorder rather than a mental illness. Specifically, the DSM-IV diagnostic criteria for narcissistic personality disorder may be applicable. This disorder is characterized by a pervasive pattern of grandiosity, a need for admiration, and a lack of empathy, which typically begins in early adulthood and is present in various contexts. To meet the diagnostic criteria, an individual must exhibit at least five of the following: a grandiose sense of self-importance, preoccupation with fantasies of unlimited success of power, a belief that they are special and unique, a need for excessive admiration, a sense of entitlement, interpersonal exploitation, a lack of empathy, envy of others, and arrogant or haughty behaviors or attitudes.
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This question is part of the following fields:
- Diagnosis
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Question 8
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A 79-year-old man has been out of contact with his daughter for several weeks whilst she has been on vacation. Upon her return, she finds him confused and unclothed on the couch in his apartment. He is unsteady on his feet and unable to recall how long he has been there, suggesting that he has also just returned from vacation. He points to rats on the floor of his apartment, which his daughter cannot see. He is taken to the hospital, where he is diagnosed with ataxia and ophthalmoplegia. Which of the following conditions would make this man more susceptible to the most probable diagnosis?
Your Answer: Alcohol dependence
Explanation:The most likely cause of the patient’s symptoms is alcohol dependence, which can lead to a depletion of B1 stores and result in Wernicke’s encephalopathy. While hypertension and type 2 diabetes are risk factors for vascular disease, they typically present with focal neurological signs rather than confusion. The patient’s triad of confusion, ataxia, and ophthalmoplegia, along with visual hallucinations and confabulation, suggest a Korsakoff’s psychosis, which can result from a thiamine deficiency. While anorexia nervosa can also cause B1 deficiency, it is an unlikely condition in an elderly gentleman, and other conditions causing malabsorption can also trigger Wernicke’s. While diabetics can experience delirium from low blood sugars and infections, the specific symptoms described here are not typical of these causes. While people with learning difficulties may be more prone to delirium with concurrent illness, it is not likely to cause the specific triad of symptoms seen in this patient.
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- Diagnosis
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Question 9
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A 45-year-old woman is in a car accident where several individuals lose their lives. Although she is not physically harmed, she experiences a sense of detachment, confusion, and disorientation in the days that ensue, along with physical symptoms of trembling and perspiration. What is the most probable diagnosis?
Your Answer: Acute stress disorder
Explanation:Acute stress disorder is a brief yet intense condition triggered by a highly distressing event that can cause a range of symptoms. Although the symptoms can appear quickly, they typically subside within a few days. These symptoms may include psychological effects like feeling disconnected of confused, as well as physical symptoms such as sweating, trembling, heart palpitations, and difficulty sleeping. In some cases, individuals may progress to develop post-traumatic stress disorder.
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This question is part of the following fields:
- Diagnosis
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Question 10
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A 45-year-old female patient was started on an antipsychotic medication for the first time. She presented with fluctuating blood pressure, hyperthermia, confusion, urinary incontinence, and elevated levels of creatinine kinase. What is the diagnosis?
Your Answer: Neuroleptic malignant syndrome
Explanation:Neuroleptic malignant syndrome (NMS) is a serious and potentially fatal complication of neuroleptic treatment that is characterized by hyperthermia, rigidity, confusion, diaphoresis, autonomic instability, elevated creatinine phosphokinase, and leukocytosis. It can occur at any time during antipsychotic treatment and is often misdiagnosed as an exacerbation of psychosis. Therefore, it is crucial to accurately diagnose NMS.
Dystonias are abnormal movements of postures caused by brief of prolonged muscle contractions, including oculogyric crisis, tongue protrusion, trismus, torticollis, laryngeal pharyngeal dystonias, and dystonic postures of limbs and trunk.
Symptoms of parkinsonism include muscle stiffness (lead pipe rigidity), cogwheel rigidity, shuffling gait, stooped posture, and drooling. The pill rolling tremor of idiopathic parkinsonism is rare, but a regular coarse tremor similar to essential tremor may be present.
Tardive dyskinesia is a delayed effect of antipsychotics that rarely occurs until after six months of treatment. Tardive dystonia is a form of drug-induced secondary dystonia.
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This question is part of the following fields:
- Diagnosis
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Question 11
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Based on the provided information, what is the probable diagnosis for Mr Smith's previous mental health condition, given his lifelong tendencies towards perfectionism and high standards that have caused conflicts in his personal and professional life, as well as strained relationships with family members?
Your Answer: Obsessive-compulsive/anankastic personality disorder
Explanation:The consistent and long-standing nature of this behavior suggests that it may be indicative of a personality of developmental disorder. According to the DSM-IV criteria for obsessive-compulsive personality disorder, individuals may exhibit a pervasive preoccupation with orderliness, perfectionism, and control in various contexts, often at the expense of flexibility, efficiency, and openness. To meet the criteria for this disorder, an individual must display at least four of the following behaviors: excessive concern with details, rules, lists, order, of schedules; perfectionism that interferes with task completion; excessive devotion to work and productivity; over-conscientiousness and inflexibility regarding morality, ethics, of values; difficulty discarding worthless objects; reluctance to delegate tasks of work with others; a miserly spending style; and rigidity and stubbornness.
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This question is part of the following fields:
- Diagnosis
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Question 12
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Which of the following is indicative of a hypomanic episode in an individual diagnosed with bipolar disorder?
Your Answer: Disturbance of psychosocial function
Explanation:Hypomania is a milder form of mania (F30.1) that lacks hallucinations of delusions but still presents persistent and noticeable changes in mood and behavior that exceed those seen in cyclothymia (F34.0). To diagnose hypomania, these features must be present for several consecutive days and cause significant interference with work of social activity. However, if the disruption is severe of complete, mania (F30.1 of F30.2) should be considered instead.
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This question is part of the following fields:
- Diagnosis
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Question 13
Incorrect
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Which statement below best describes Cotard's syndrome?
Your Answer: Is most common in schizophrenia
Correct Answer: Occurs mostly in elderly age group
Explanation:Cotard’s syndrome is a disorder characterized by sudden onset of nihilistic delusions, including beliefs of poverty, negation, and meaninglessness. Hypochondriacal delusions and feelings of guilt may also be present. This condition is more prevalent in elderly individuals and females, and is often associated with depression and organic illnesses.
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This question is part of the following fields:
- Diagnosis
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Question 14
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Samantha is a middle-aged woman who has been brought to the Emergency department by her husband. He is concerned about her recent behavior and wants her to be evaluated by a medical professional.
Samantha is initially resistant to speaking with you, stating that she only wants to speak with a specialist. She explains that she is a successful businesswoman and needs to be treated by someone who understands her unique needs. She is unsure why her husband has brought her in, but suspects that he is jealous of her success. As she speaks, she paces the room and is anxious to return to work.
Her husband tells you that Samantha has been working long hours and has become increasingly irritable and demanding. She has been spending a lot of money on expensive clothes and accessories, and he recently discovered that she has been using their joint credit card to make these purchases. When confronted, Samantha said that she needed to look her best to maintain her professional image and that she deserved to treat herself.
What is the most likely diagnosis?Your Answer: Mania
Explanation:It is important to note that there is no collateral history available and the duration of the observed behaviour pattern is unknown. Additionally, the individual’s excessive panting and pacing may indicate motor over-activity, which is consistent with symptoms of mania. Therefore, it is necessary to consider the possibility of a drug-induced state as a potential differential diagnosis. However, until further information is obtained, it is crucial to treat this as an episode of mania.
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This question is part of the following fields:
- Diagnosis
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Question 15
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A 35-year-old firefighter comes to the hospital six weeks after responding to a major fire incident. He is worried that he might be suffering from post-traumatic stress disorder (PTSD).
What symptom would be the most indicative of this diagnosis?Your Answer: Flashbacks of the traumatic event
Explanation:While EMDR can be beneficial for various disorders, its effectiveness does not hold any diagnostic significance for PTSD. The presence of flashbacks of distressing reliving experiences is the primary requirement for diagnosing PTSD, and other symptoms such as autonomic disturbance, avoidance of work, and increased sensitivity to noise are not necessary for diagnosis.
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- Diagnosis
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Question 16
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A 37-year-old woman is experiencing constant fatigue~ sadness~ and tearfulness~ as well as poor sleep. These symptoms have been present for the past 3 months. She recently delivered her third child 4 months ago. She has lost interest in socializing~ work~ and sex~ and feels guilty for not being able to feel happy despite having a healthy baby and a supportive family. What is the most probable diagnosis?
Your Answer: Postpartum depression
Explanation:It is highly probable that the individual is experiencing postpartum depression, as all the symptoms are characteristic and have manifested within a year of giving birth. While the ‘baby blues’ is a brief and immediate response, postnatal depression typically develops within two to three months after delivery.
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This question is part of the following fields:
- Diagnosis
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Question 17
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As the liaison psychiatry doctor on-call, you are requested to assess a 42-year-old male patient in the early hours of the morning on a general medical ward. He was admitted with pancreatitis twelve hours ago and has been medically cleared. The patient has no significant past medical of psychiatric history, but he has become paranoid and delusional, believing that there are bugs crawling under his skin. What is the probable diagnosis?
Your Answer: Delirium tremens (DTs)
Explanation:The presence of acute psychosis, visual hallucinations, and formications in an individual with pancreatitis likely caused by alcohol suggests severe alcohol withdrawal of DTs, which should have been prevented with prophylactic treatment using Librium (chlordiazepoxide). Schizophrenia is improbable due to the patient’s age, sudden onset of symptoms, and lack of first rank symptoms. Korsakoff’s of amnesic syndrome typically precedes Wernicke’s, and parenteral Pabrinex (thiamine) is usually administered prophylactically. Since the patient was an inpatient, it is unlikely that he had access to illicit drugs, and the absence of post-seizure psychosis rules out that possibility.
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This question is part of the following fields:
- Diagnosis
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Question 18
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What is a common compulsion that may be present in individuals with OCD?
Your Answer: Checking locks
Explanation:The typical compulsive behaviors in OCD involve checking locks, taps, and safety issues, which serve to alleviate anxiety and reinforce the behavior. Breath-holding is not a common manifestation of OCD, nor is hand-wringing of stepping on cracks in the pavement. While fear of contamination is a common obsession, it is not a compulsion in and of itself. Instead, the compulsion typically involves behaviors aimed at avoiding contamination.
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- Diagnosis
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Question 19
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Mrs. Johnson is a 45-year-old woman who has been referred to you by her therapist. She has a history of pursuing over 40 cases against various individuals, services, and authorities. Many of these cases have been dismissed as frivolous.
She works as a receptionist, but presents as someone capable of more challenging work. She reports being fired from several jobs due to discrimination and mistreatment.
Mrs. Johnson is divorced, following her husband's infidelity. After the divorce, she told her children they could either continue to see her of their father. They chose to maintain a relationship with both parents, but Mrs. Johnson is unable to accept this.
What is the most likely diagnosis?Your Answer: Paranoid personality disorder
Explanation:The symptoms described in the scenario could be consistent with various diagnoses, but the most appropriate diagnosis is paranoid personality disorder. This disorder is characterized by several symptoms, including excessive sensitivity to setbacks, persistent grudges, distorted perceptions of others’ actions, a strong sense of personal rights, unfounded suspicions of infidelity, self-importance, and preoccupation with conspiracies.
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- Diagnosis
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Question 20
Correct
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A 12-year-old child has several tics. What is a characteristic symptom of Tourette's syndrome?
Your Answer: Vocal tics
Explanation:Tourette’s syndrome, also known as combined vocal and motor tic disorder, is characterized by multiple motor tics and one of more vocal tics. Inattention may be present but is not a defining symptom. Coprophagia, of the act of eating feces, is not associated with Tourette’s syndrome and is more commonly seen in individuals with learning difficulties of chronic psychotic disorders. Glossolalia, of speaking in tongues, is not related to psychopathology and is not a feature of Tourette’s syndrome.
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