Thursday, 1 October 1992

FCPS-2 Psychiatry Paper CPSP October 1992

College Of Physicians & Surgeons, Pakistan

F.C.P.S. PART II EXAMINATION - OCTOBER 1992

SUBJECT:  PSYCHIATRY

Paper-I

Instructions:

1)  Answer all questions.

2)  Use separate answer books for each question.

  Answer the following briefly:-

a)    Name five laboratory and four radiological investigations that you would consider while investigating dementia

b)     Enumerate five consequences of the victims of child sexual abuse.

c)     Name five behavioral methods that are effective in the treatment of obsessional disorders.

d)     What are the current indications of psychosurgery? Name four complications and what is its mortality rate.

e)     ’Define therapeutic factors in group psychotherapy. Who described them? Name ten of these factors.

f)      Name five causes of Wernicke's encephalopathy. What are the three principal features of this syndrome?

g)     Define the term ” alexithymia”. Who coined it? Name five of its essential features.

h)   Name five clinical features of turner’s syndrome. Name two laboratory analyses for this condition.

2.     Nausheen, a 16-year-old stage dancer, was taken to the psychologist by her mother. She complained that ever since she and her heroin addict husband had separated six months ago, her daughter had been ’out of control ’ . About this time Nausheen was caught shoplifting earrings from a general store because ’ I just liked them and waved them ’ as she explained. In subsequent weeks nausheen started crying at the slightest provocation and complaining that she felt ugly and she began locking herself in her bedroom. Each evening after a typically small dinner. Stopped taking breakfast before leaving for school and her teacher reported in confidence that nausheen had been seen smoking at lunchtime. When nausheen complained of always ’being tired and having stomach aches, her medical check-up reveals so low serum potassium mildly elevated bun, swollen but painless parotid glands, and an unusual scarring and callus formation on the .dorsum of second and third fingers of her right’, hand. The family doctor suggested she begin eating her breakfast and not worry so much about her weight. After all 115 ibs vas just right for her height of 5 ’ 3”. On his suggestion ’ nausheen was taken to the psychologist. There she was counseled for a few weeks about accepting her parent’s separation. 

A dentist finally made the correct diagnosis during nausheen’s annual check-up.

 

a)      What is the most likely diagnosis?

b)     What  led  the  dentist to make  the  correct diagnosis?

c)      This problem has been compared to substance Abuse.

d)     What features do these diagnoses have in Common?

e)      Describe the salient features of the disorder.

f)      What medication can be prescribed for this patient?

 

  1. Write an essay on psychiatric aspects of liver disease.

 

  1. “All psychiatrists are neurologists,  but the psychiatrists don’t know this ” In the light of this statement critically evaluate with references to recent research and literature review. Is the concept of fronto-subcortical dementia relevant to schizophrenia?

 

  1. Answer the following briefly:-

 

  1. Define akathisia. What causes it?

  2. What neurotransmitters it involves?

  3. Name three contraindications of performing a lumbar puncture.

  4.  Name three hematological and three metabolic disturbances  (other than endocrine changes) encountered in anorexia nervosa.

  5. What are the five axes of the ICD 9 for the classification of child psychiatric syndromes?

  6. name ten favorable prognostic factors in anorexia nervosa.

  7. Regarding the pathology of Alzheimer's disease, describe four macroscopic and five microscopic changes.

  8. An obstetrician has asked you about the managhmen’i1 of lithium during pregnancy. What advice would you give?

  9. You have been asked by the relative of an elderly intermittently confused man whether he is mentally fit to make a will. Name four factors that you would consider.

  10. Define pseudo-dementia. Name four different ways in which we can differentiate it from dementia. Name six causes of pseudodementia.


 

  1. Critically evaluate the work done to study the behavior simulating suicide. How would you assess such a case, in particular, the prognosis of the case?

 

  1. Describe briefly the psychological basis of the adolescent question ” who am I”? Write brief notes on:-

 

  1. Biological and psychological aspects of criminal behavior.

  2. Proposed mental health act of Pakistan 1992

 

  1. Write an essay on the ways in which mental health services might best work with primary care and general medical services. Discuss the public health implications of such a model.

 



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