103. A psychiatric consultation was sought to evauate depression in a 56-year-old male with pancreatic cancer. His severe back pain was being well-treated with morphine. The patient was noted by the inpatient staff to be more withdrawn, disengaged, and quiet, making poor eye contact and sleeping most of the day. On examination, the psychiatric consultant found the man to be difficult to arouse and to be mildly confused and disoriented. His speech was slow and his thought process disorganized. He admitted to intermittently experiencing visual hallucinations that he had been too embarrassed to report earlier to the nursing staff. The man was diagnosed with a hypoactive delirium secondary to opioid medications. Which of the following is the most appropriate next step in his management?
A. Decrease dose of morphine.
B. Decrease frequency of morphine.
C. Discontinue morphine.
D. Do nothing.
E. Add an antipsychotic.
Sunday 17 February 2008
1. you are called for to consult on a 42-year-old woman with alcohol dependence who is complaining of severe depressive symptoms despite 5 days of abstinence. In the initial stage of the interview she noted that she had “ always been depressed” and believed that she “drank to cope with the depression”. Her current complaint included a prominent sadness that had persisted for several weeks, difficulties concentrating, initial and terminal insomnia, and a feeling of hopelessness and guilt. What is the most approximate next step to distinguish between alcohol-induced depression and an independent major depressive episode?
A. Antidepressant treatment.
B. Intensive psychotherapy.
C. Proton emission tomography(PET)scan.
D. Chronological history.
E. Trial of ECT.
2. After initiating lithium therapy when should the plasma level be checked?
A. 12 hours
B. 12–24 hours
C. 24–48 hours
D. 3–5 days
E. 5–7 days
3. Which of the following statements relates to buspirone?
A. Is a cyclopyrrolone compound
B. Side-effects include sedation
C. Can cause hyperprolactinaemia
D. Can be administered to patients with epilepsy
E. Is useful in the treatment of panic disorder
4. A 2-year-old young girl uses only one word – 'Daddy' – to everyone she encounters. You are asked to diagnose if she has any delay in language development or any other psychological factor causing this behaviour. It does not appear to be a form of stammering or stuttering. She has normal psychomotor development and the examination is otherwise entirely normal. How would you best describe her present state of language?
A. Over-extension
B.Under-extension
C. Telegraphic word
D. Holophrases
E. Grammatical morphemes
A. Antidepressant treatment.
B. Intensive psychotherapy.
C. Proton emission tomography(PET)scan.
D. Chronological history.
E. Trial of ECT.
2. After initiating lithium therapy when should the plasma level be checked?
A. 12 hours
B. 12–24 hours
C. 24–48 hours
D. 3–5 days
E. 5–7 days
3. Which of the following statements relates to buspirone?
A. Is a cyclopyrrolone compound
B. Side-effects include sedation
C. Can cause hyperprolactinaemia
D. Can be administered to patients with epilepsy
E. Is useful in the treatment of panic disorder
4. A 2-year-old young girl uses only one word – 'Daddy' – to everyone she encounters. You are asked to diagnose if she has any delay in language development or any other psychological factor causing this behaviour. It does not appear to be a form of stammering or stuttering. She has normal psychomotor development and the examination is otherwise entirely normal. How would you best describe her present state of language?
A. Over-extension
B.Under-extension
C. Telegraphic word
D. Holophrases
E. Grammatical morphemes
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