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 The patient was noted by the inpatient staff to be more withdrawn, disengaged, and quiet, making poor eye contact and sleeping most of the day.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
Sunday, 20 January 2008
1. Beliefs and symptoms may reach delusional intensity
A. Hypochondriasis.
B. Body Dysmorphic Syndrome.
C. Both.
D. Neither.
2. The first sign of beginning cerebral disease is impairment of
A. Recent memory.
B. Remote memory.
C. Long-term memory.
D. Immediate memory.
E. None.
3. Retention of information over the past few months, like current events
A. Immediate memory.
B. Semantic Memory.
C. Implicit memory.
D. Recent past memory.
E. Episodic memory.
4. 95. Which of the following is not a healthy defence mechanism?
A. Denial.
B. Humor.
C. Altruism.
D. Suppression.
E. Sublimation.
5. Delusional disorder
A. Is caused by frontal lobe lesions.
B. Is an early stage of Schizophrenia.
C. Usually begins by age 20.
D. Is less common that schizophrenia.
E. Is more common in men that in women.
A. Hypochondriasis.
B. Body Dysmorphic Syndrome.
C. Both.
D. Neither.
2. The first sign of beginning cerebral disease is impairment of
A. Recent memory.
B. Remote memory.
C. Long-term memory.
D. Immediate memory.
E. None.
3. Retention of information over the past few months, like current events
A. Immediate memory.
B. Semantic Memory.
C. Implicit memory.
D. Recent past memory.
E. Episodic memory.
4. 95. Which of the following is not a healthy defence mechanism?
A. Denial.
B. Humor.
C. Altruism.
D. Suppression.
E. Sublimation.
5. Delusional disorder
A. Is caused by frontal lobe lesions.
B. Is an early stage of Schizophrenia.
C. Usually begins by age 20.
D. Is less common that schizophrenia.
E. Is more common in men that in women.
Saturday, 5 January 2008
Competition 'tough' for NHS posts
By Branwen Jeffreys Health correspondent, BBC News
Junior doctors across the UK are being warned the competition they will face this year for specialist training jobs in the NHS will be tougher than ever.
As recruitment begins for August, the NHS employers body says there may be an average of three applicants per post.
Many applicants will be NHS doctors who qualified outside the EU, after the government failed in a 2007 legal bid to give UK medical graduates priority.
Without a training post a junior doctor cannot become a consultant or GP.
It is a good thing for patients that there is competition for jobs - it should mean they get the best doctors wherever they live Sian Thomas NHS Employers
After a computer fiasco and complaints of unfairness when a new system was introduced for 2007, the process for this year has been changed.
The controversial system - known as the medical training application service (MTAS) - was shelved by ministers.
Doctors complained about a lack of posts, poorly designed recruitment forms, and technical failures with the online application system.
In the wake of the controversy, BMA chairman James Johnson resigned amid accusations that he had failed to put across the feelings of doctors about the system.
Now, thousands of applications will be handled by local medical deaneries and there is no limit to the number of applications an individual doctor can make.
In England there will be around 9,000 places on speciality training programmes and employers expect there may be as many as 23,000 applications.
Competition welcomed
Sian Thomas, from NHS Employers, said young doctors needed to make realistic decisions.
In some popular specialities, such as surgery, there may be as many as 10 applications for each training post, she said.
"It is a good thing for patients that there is competition for jobs - it should mean they get the best doctors wherever they live."
One reason the competition for jobs is expected to be intense is the large number of overseas doctors who want specialist training in the UK.
Our concern is that without adequate planning, the levels of competition could result in a lottery Ram Moorthy BMA Junior Doctors Committee
In 2008 it is expected that doctors who qualified outside the EU may make up half the applications for training posts.
But UK medical schools have also increased the number of doctors they are training, at an estimated cost to the taxpayer of £250,000 for every medical graduate.
Pressure group Remedy UK has launched a specialist website to help doctors with their job search.
Remedy UK's Chris McCullough said: "Our view is that the system is essentially appalling.
"Doctors aren't afraid of competition, but what we have this year is doctors facing a one-in-19 chance of getting a job in some areas."
The Department of Health tried to give UK medical graduates priority in the recruitment process this year, but that was overturned after a legal challenge.
Now the government is appealing to the House of Lords but any decision will be too late to affect the rules for 2008.
Fears of unfairness
A Department of Health spokesman said: "Doctors from outside Europe have made and continue to make a huge contribution to the NHS.
"The issue is not, and never has been, whether they can continue to work as NHS doctors - which they can - but whether the taxpayer should be investing in training them instead of UK medical graduates."
The British Medical Association is worried that the volume of applications this year could overwhelm medical deaneries.
It said it would be monitoring the process to ensure fairness.
Ram Moorthy, chairman of the BMA junior doctors committee, said: "Our concern is that without adequate planning, the levels of competition could result in a lottery.
"Trusts need to get their recruitment practices in order, and start preparing now to ensure that there is no unfairness, and no negative impact on patient care."
Junior doctors across the UK are being warned the competition they will face this year for specialist training jobs in the NHS will be tougher than ever.
As recruitment begins for August, the NHS employers body says there may be an average of three applicants per post.
Many applicants will be NHS doctors who qualified outside the EU, after the government failed in a 2007 legal bid to give UK medical graduates priority.
Without a training post a junior doctor cannot become a consultant or GP.
It is a good thing for patients that there is competition for jobs - it should mean they get the best doctors wherever they live Sian Thomas NHS Employers
After a computer fiasco and complaints of unfairness when a new system was introduced for 2007, the process for this year has been changed.
The controversial system - known as the medical training application service (MTAS) - was shelved by ministers.
Doctors complained about a lack of posts, poorly designed recruitment forms, and technical failures with the online application system.
In the wake of the controversy, BMA chairman James Johnson resigned amid accusations that he had failed to put across the feelings of doctors about the system.
Now, thousands of applications will be handled by local medical deaneries and there is no limit to the number of applications an individual doctor can make.
In England there will be around 9,000 places on speciality training programmes and employers expect there may be as many as 23,000 applications.
Competition welcomed
Sian Thomas, from NHS Employers, said young doctors needed to make realistic decisions.
In some popular specialities, such as surgery, there may be as many as 10 applications for each training post, she said.
"It is a good thing for patients that there is competition for jobs - it should mean they get the best doctors wherever they live."
One reason the competition for jobs is expected to be intense is the large number of overseas doctors who want specialist training in the UK.
Our concern is that without adequate planning, the levels of competition could result in a lottery Ram Moorthy BMA Junior Doctors Committee
In 2008 it is expected that doctors who qualified outside the EU may make up half the applications for training posts.
But UK medical schools have also increased the number of doctors they are training, at an estimated cost to the taxpayer of £250,000 for every medical graduate.
Pressure group Remedy UK has launched a specialist website to help doctors with their job search.
Remedy UK's Chris McCullough said: "Our view is that the system is essentially appalling.
"Doctors aren't afraid of competition, but what we have this year is doctors facing a one-in-19 chance of getting a job in some areas."
The Department of Health tried to give UK medical graduates priority in the recruitment process this year, but that was overturned after a legal challenge.
Now the government is appealing to the House of Lords but any decision will be too late to affect the rules for 2008.
Fears of unfairness
A Department of Health spokesman said: "Doctors from outside Europe have made and continue to make a huge contribution to the NHS.
"The issue is not, and never has been, whether they can continue to work as NHS doctors - which they can - but whether the taxpayer should be investing in training them instead of UK medical graduates."
The British Medical Association is worried that the volume of applications this year could overwhelm medical deaneries.
It said it would be monitoring the process to ensure fairness.
Ram Moorthy, chairman of the BMA junior doctors committee, said: "Our concern is that without adequate planning, the levels of competition could result in a lottery.
"Trusts need to get their recruitment practices in order, and start preparing now to ensure that there is no unfairness, and no negative impact on patient care."
1. A 23-year-old woman complains that her mother is selfish, stupid and cunning. At the same time, she praises another relative whom she describes as kind, wise and helpful. Which defence mechanism is suggested by this behaviour?
A. Conversion
B. Idealisation
C. Symbolisation
D. Splitting
E.Projection
2. A 9-year-old boy constantly disobeys his parents and teachers. He gets along well with his peers and completes projects that he likes. His developmental milestones are normal and he has no history of fighting, theft or destruction of property. Mental status examination reveals an assertive child who tells the examiner that he does not wish to discuss his problems. What is the most likely diagnosis?
A. Oppositional defiant disorder
B. Mental retardation
C. Conduct disorder
D. Childhood disintegrative disorder
E. Attention-deficit hyperactivity disorder
3. A teenage girl complains that her mother interferes in every aspect of her life and tries to control her. The girl no longer speaks to her parents or eats meals with them. The mother has increased her efforts to maintain control. What condition could arise from this situation?
A. Anorexia nervosa
B. Dissociative identity disorder
C. Narcissistic personality disorder
D. Schizophrenia
E. Separation anxiety disorder
4. after an automobile accident that kills her child but leaves her with only minor injuries, a mother appears very calm and says that she has no emotion. What mechanism is she using?
A. Derealisation
B. Isolation
C. Depersonalisation
D. Disorientation
E. Intellectualisation
5. CT scan image that shows enlargement of the ventricles due to atrophy of the head of the Caudate Nucleus is usually found in:
A. Lewy body dementia.
B. Alzheimer’s disease.
C. Pick’s disease.
D. Huntington’s disease.
E. Parkinson’s disease.
6. Which of the following is not one of the basic elements of the Insanity Defence?
A. Finding of incompetence to stand trial.
B. Presence of a defect of reason.
C. Presence of a mental disorder.
D. Incapacity to refrain from the act.
E. Lack of knowledge of the nature of the act.
A. Conversion
B. Idealisation
C. Symbolisation
D. Splitting
E.Projection
2. A 9-year-old boy constantly disobeys his parents and teachers. He gets along well with his peers and completes projects that he likes. His developmental milestones are normal and he has no history of fighting, theft or destruction of property. Mental status examination reveals an assertive child who tells the examiner that he does not wish to discuss his problems. What is the most likely diagnosis?
A. Oppositional defiant disorder
B. Mental retardation
C. Conduct disorder
D. Childhood disintegrative disorder
E. Attention-deficit hyperactivity disorder
3. A teenage girl complains that her mother interferes in every aspect of her life and tries to control her. The girl no longer speaks to her parents or eats meals with them. The mother has increased her efforts to maintain control. What condition could arise from this situation?
A. Anorexia nervosa
B. Dissociative identity disorder
C. Narcissistic personality disorder
D. Schizophrenia
E. Separation anxiety disorder
4. after an automobile accident that kills her child but leaves her with only minor injuries, a mother appears very calm and says that she has no emotion. What mechanism is she using?
A. Derealisation
B. Isolation
C. Depersonalisation
D. Disorientation
E. Intellectualisation
5. CT scan image that shows enlargement of the ventricles due to atrophy of the head of the Caudate Nucleus is usually found in:
A. Lewy body dementia.
B. Alzheimer’s disease.
C. Pick’s disease.
D. Huntington’s disease.
E. Parkinson’s disease.
6. Which of the following is not one of the basic elements of the Insanity Defence?
A. Finding of incompetence to stand trial.
B. Presence of a defect of reason.
C. Presence of a mental disorder.
D. Incapacity to refrain from the act.
E. Lack of knowledge of the nature of the act.
Wednesday, 26 December 2007
1. physiological activity associated with PTSD include all except:
A. Decreased parasympathetic tone.
B. Excessive sweating.
C. Increased blood pressure.
D. Increased circulating thyroxine.
E. Elevated baseline heart rate.
2. A 72 year-old lady with 4 months history of memory loss, urinary incontinence and falls. On examination she has mild memory loss and a broad based, slow gait. Muscle tone is normal and both plantar reflexes are down going. What is the likely diagnosis?
A) Alzheimer's disease
B ) Frontal lobe dementia
C ) Multi-infarct dementia
D ) Normal pressure hydrocephalus
E) Parkinson's disease
3. A 73-year-old man with advanced Parkinson's disease is being treated on the ward for a urinary tract infection. His regular medicationincludes co-careldopa, entacapone, cabergoline, and prn subcutaneousapomorphine injections. His wife tells you that for the last month hisbehaviour has changed and he has become agitated, disinhibited and hekeeps asking her for money. His dyskinesia has also become more
denies having hallucinations and, after probing questioning, you canfind no evidence of delusional thought. Mood assessment shows him tobe cheerful and there are no cognitive or biological features ofdepression. What is the likely physiological cause of the behaviouralchange?
A. Reduced breakdown of dopamine
B. Change in sensitivity to dopamine
C. Confusional state due to urosepsis
D. Direct dopamine agonism
E. Coexisting dementia
4. 15. A 24-year-old man is admitted to the psychiatric ward from home, where he lives alone. His neighbours have been increasingly concerned about rubbish piling up inside his flat and sometimes he isn't seen fordays. His family tell you that over the last year he has become veryodd and isolated. On examination, he is withdrawn and quiet and youfind it difficult to understand his answers as he frequently wandersoff the point, as if he is answering a different question. Althoughspontaneous movements are reduced, there are no neurological signs and
older brothers have both had episodes of major depression. Are thereany features that suggest a favourable outcome from this episode?
A. Young age
B. Insidious onset
C. No favourable features
D. Quiet speech
E. Family history of depression
5. An 83-year-old man is undergoing cognitive assessment in apsychogeriatric clinic. He was referred because of a change in hisbehaviour, and his wife has noticed a few aggressive outbursts overthe past months. His Mini-Mental test score is 18. Which patterns ofcognitive deficit would favour a dementia of subcortical origin?
A. Poor Visuospatial performance
B. Preserved verbal fluency
C. Severe memory disturbance
D. Constructional apraxia
E. Reduced verbal output
6. A 77 year old woman complains of memory loss. Which of the following makes a diagnosis of pseudodementia less likely:-
A. Rapid onset
B. Depressed mood
C. Patchy memory loss
D. Great effort in performing tests
E. Rapid progression
A. Decreased parasympathetic tone.
B. Excessive sweating.
C. Increased blood pressure.
D. Increased circulating thyroxine.
E. Elevated baseline heart rate.
2. A 72 year-old lady with 4 months history of memory loss, urinary incontinence and falls. On examination she has mild memory loss and a broad based, slow gait. Muscle tone is normal and both plantar reflexes are down going. What is the likely diagnosis?
A) Alzheimer's disease
B ) Frontal lobe dementia
C ) Multi-infarct dementia
D ) Normal pressure hydrocephalus
E) Parkinson's disease
3. A 73-year-old man with advanced Parkinson's disease is being treated on the ward for a urinary tract infection. His regular medicationincludes co-careldopa, entacapone, cabergoline, and prn subcutaneousapomorphine injections. His wife tells you that for the last month hisbehaviour has changed and he has become agitated, disinhibited and hekeeps asking her for money. His dyskinesia has also become more
denies having hallucinations and, after probing questioning, you canfind no evidence of delusional thought. Mood assessment shows him tobe cheerful and there are no cognitive or biological features ofdepression. What is the likely physiological cause of the behaviouralchange?
A. Reduced breakdown of dopamine
B. Change in sensitivity to dopamine
C. Confusional state due to urosepsis
D. Direct dopamine agonism
E. Coexisting dementia
4. 15. A 24-year-old man is admitted to the psychiatric ward from home, where he lives alone. His neighbours have been increasingly concerned about rubbish piling up inside his flat and sometimes he isn't seen fordays. His family tell you that over the last year he has become veryodd and isolated. On examination, he is withdrawn and quiet and youfind it difficult to understand his answers as he frequently wandersoff the point, as if he is answering a different question. Althoughspontaneous movements are reduced, there are no neurological signs and
older brothers have both had episodes of major depression. Are thereany features that suggest a favourable outcome from this episode?
A. Young age
B. Insidious onset
C. No favourable features
D. Quiet speech
E. Family history of depression
5. An 83-year-old man is undergoing cognitive assessment in apsychogeriatric clinic. He was referred because of a change in hisbehaviour, and his wife has noticed a few aggressive outbursts overthe past months. His Mini-Mental test score is 18. Which patterns ofcognitive deficit would favour a dementia of subcortical origin?
A. Poor Visuospatial performance
B. Preserved verbal fluency
C. Severe memory disturbance
D. Constructional apraxia
E. Reduced verbal output
6. A 77 year old woman complains of memory loss. Which of the following makes a diagnosis of pseudodementia less likely:-
A. Rapid onset
B. Depressed mood
C. Patchy memory loss
D. Great effort in performing tests
E. Rapid progression
Tuesday, 25 December 2007
Psychiatry BoFs
1. Which of the following statements regarding rapid cycling bipolar disorder is true?
A. Often responds to tricyclic antidepressants.
B. Hospitalisation of these patients is rare.
C. More common in men than women.
D. Alcohol, stimulants or caffeine use is risk factors.
E. Defined as at least 4 episodes per month.
2. true statements about structural brain abnormalities in patients with schizophrenia include:
A. Abnormalities have not been correlated with cognitive deficits.
B. Abnormalities are present from birth.
C. Abnormalities are present in a minority of patients.
D. None
E. Cortical involvement is multifocal rather than diffuse.
3. Memory for knowledge and facts , like the first president of the united states:
A. Episodic memory.
B. Recent past memory.
C. Immediate memory.
D. Semantic memory.
E. Implicit memory.
4. A 45-year-old woman attends her GP surgery complaining of poor sleep. On closer questioning she says she avoids leaving the house because she is scared of people looking at her, and 2 weeks ago at a restaurant she had an episode of tachycardia and breathlessness with intense fear. What is the likely diagnosis?
A. Agoraphobia
B. Social phobia
C. Panic disorder
D. Generalised anxiety disorder
E. Depression
5. 4. A 25-year-old man is started on chlorpromazine having been diagnosed as suffering from paranoid schizophrenia. Two months later he is seen in clinic as an emergency due to concerns from his friends over an apparent deterioration in his mental state. The patient complains of an extremely distressing sense of restlessness and a complete inability to remain still. On examination he shifts constantly in his chair and fidgets with his coat. There is a slight increase in tone on the right side and a detectable resting tremor in the hands. He describes some vague feelings of 'being watched' but there are no other psychotic symptoms elicited. Which one of the following is the MOST likely diagnosis?
a. Acute dystonic reaction due to chlorpromazine
b. Breakthrough of his psychotic symptoms
c. Akathisia
d. Tardive dyskinesia
e. Tardive dystonia
A. Often responds to tricyclic antidepressants.
B. Hospitalisation of these patients is rare.
C. More common in men than women.
D. Alcohol, stimulants or caffeine use is risk factors.
E. Defined as at least 4 episodes per month.
2. true statements about structural brain abnormalities in patients with schizophrenia include:
A. Abnormalities have not been correlated with cognitive deficits.
B. Abnormalities are present from birth.
C. Abnormalities are present in a minority of patients.
D. None
E. Cortical involvement is multifocal rather than diffuse.
3. Memory for knowledge and facts , like the first president of the united states:
A. Episodic memory.
B. Recent past memory.
C. Immediate memory.
D. Semantic memory.
E. Implicit memory.
4. A 45-year-old woman attends her GP surgery complaining of poor sleep. On closer questioning she says she avoids leaving the house because she is scared of people looking at her, and 2 weeks ago at a restaurant she had an episode of tachycardia and breathlessness with intense fear. What is the likely diagnosis?
A. Agoraphobia
B. Social phobia
C. Panic disorder
D. Generalised anxiety disorder
E. Depression
5. 4. A 25-year-old man is started on chlorpromazine having been diagnosed as suffering from paranoid schizophrenia. Two months later he is seen in clinic as an emergency due to concerns from his friends over an apparent deterioration in his mental state. The patient complains of an extremely distressing sense of restlessness and a complete inability to remain still. On examination he shifts constantly in his chair and fidgets with his coat. There is a slight increase in tone on the right side and a detectable resting tremor in the hands. He describes some vague feelings of 'being watched' but there are no other psychotic symptoms elicited. Which one of the following is the MOST likely diagnosis?
a. Acute dystonic reaction due to chlorpromazine
b. Breakthrough of his psychotic symptoms
c. Akathisia
d. Tardive dyskinesia
e. Tardive dystonia
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