Wednesday, 1 October 2014

FCPS-2 October 2014, College of Physicians and Surgeons Pakistan

FCPS-2 October 2014, College of Physicians and Surgeons Pakistan

Q.4 A student of BSc diagnosed with borderline personality disorder presented in an emergency after attempting self-harm following a quarrel with a boyfriend.

  1. What signs and symptoms require urgent medical treatment?
  2. What care we should take in managing this patient in the ward
  3. What psychosocial support you will activate
  4. Give instructions on discharge regarding follow-ups.

Q.5 What are the various points that differentiate between the various anxiety disorders in terms of their prevalence and clinical features?

Q.6 A 39-year-old woman is diagnosed with severe depression years after the death of her husband. She is suicidal and has active suicidal ideations and symptoms of psychosis and is not responding to treatment with antidepressants. The psychiatrist plans ECT on this patient. 

  1. What are the other indications to start ECT in severe depressive disorder
  2. What are the indications for ECT other than severe depression?
  3. Enlist the therapeutic interventions the physician can not advise that according to the Mental Health Act 2001?

7.  A 19-year-old girl had gone to spend her summer vacations at her uncle’s house in the other city. One day, about 15 days back, her uncle's son shows her some porn videos and seduced her to have sexual relations with him. On refusal, she was abused sexually. When she returned home, she had complaints of nightmares, jumping in bed on the opening of the door, persistent dull lower abdominal pain, irrelevant talks, over-familiarity, grandiosity, hyperactivity, distractibility, disinhibition with decreased sleep.  

  1. What are the mental health sequelae to sexual abuse at an early age?
  2. What are the three most likely differential diagnoses?
  3. What non-pharmacological options are there to manage the latter on an individual who has been subjected to sexual abuse and with the aim of these non-pharmacological treatments?

Q.10 Mr. Y is an admitted case in the Jail ward of psychiatry de undergoing treatment as a patient in pursuance of an order authority. Two days back, the parents of the patient met the consultant and requested discharge urgently as he is symptom-free. 

  1. What section of the Mental Health Act 2001 is concerned with such a patient?
  2. What does that section say? 
  3. What are the sections concerned with the admission to and treatment according to the Mental Health Act 2001?

Q.11 A 65 years old retired business manager has been brought in an emergency in a wheelchair with two days history of drowsiness, generalized rigidity of the body marked tremors, and irrelevant talking. He has a history of bipolar mood disorder for 12 years. Because of his increasing agitated behavior, they increased his lithium dose from 800 mg to 1200 mg per day, haloperidol from 7.5 mg to 15 mg per day, and lorazepam from 1 mg to 3 mg per day. He had diarrhea four days ago, which lasted for 2 days. On examination, he was disorientated and dysarthric with pulse 80/min, BP 160/90 mm, Hg, and temperature 100'F. He was confused and drowsy with diminished tendon jerks and equivocal planters. 

  1. Discuss the differential diagnosis.
  2. What further investigations will you carry out? 
  3. Give justification for each.
  4. What initial and long-term management would you advise?

Q.12 A 38-year-old lady is brought to the psychiatric outdoor clinic in a state of stupor a) What possibilities will you consider in the differential diagnosis? b) What investigations would you like to ask for? c) How will you manage her?

Q.13 In its 65" assembly, the World Health Organization adopted a resolution of the need for a comprehensive and coordinated response from health and social sectors as the mental health action plan. 

  1. What are the objectives of this plan?
  2. Highlight 5 specific ways to promote mental health in the community

Q.14 There is serious concern about the long-term use of benzodiazepine among older persons owing to adverse outcomes. However, the prevalence of benzodiazepine use in older people remains high. Considering recent advances: 

  1. Enumerate the adverse effects of benzodiazepines in the elderly. 
  2. Enumerate the reasons.
  3. What are some evidence-based interventions for withdrawal in the elderly population according to recent advances?

Q.15 What points will you keep in mind while delivering a lecture on these topics:

  1. Indication for behavior therapy
  2. Indications for family therapy.
  3. Role of the therapist in psychoanalytic psychotherapy. 
  4. Nonspecific factors in psychotherapy. 
  5. Complications of psychotherapy.

Q.16 There has been substantial uncertainty regarding the incidence of children and adolescents exposed to trauma. A recent meta-analysis evaluated this issue.  

  1. Regarding recent advances, what is the overall rate of children and adolescents exposed to trauma?
  2. Enlist the potential moderating factors in the development of children and adolescents.
  3. What are other mental health consequences in children and ad exposed to traumatic events?

Q.17 A 22 years old female patient presented to psychiatric e patient presented to psychiatric OPD with complaints of weight loss over 20%, and Body mass index. On her mental state examination, they revealed it she has real fatness, therefore she avoids food and shows a behavior aimed to lose weight by vomiting. purging excessive exercise and the use of appetite suppressants and diuretics. She also complains of the absence of menstruation for the last few months. 

  1. Enlist 10 specific questions that you would ask this patient for the assessment of eating disorder?
  2. Considering the above scenario, what is your provisional diagnosis?
  3. How will you manage this case?

18. A man is brought to a psychiatric emergency. His pulse is 100/min, BP is 170/95 mm Hg, and he is profusely sweating. He is shaky and has difficulty in giving his history. He has had difficulty falling asleep for two nights and sees spiders walking on the walls. He has been a drinker for 10 years but has had no drink for the last 3 days. 

  1. What is the most likely diagnosis?
  2. Name three psychometric scales that are used for alcohol dependence or withdrawal?
  3. Mention ten social hazards that can result from chronic alcohol abuse?

Q.19 What strategies you could employ to treat the sexual side effects in a 30-year-old male receiving treatment with an SSRI.

Q.20 A 34-year-old woman who had been married for some time is pregnant for the first time. 4 weeks after delivery, she appears to be agitated. In this state, she drowned the child in the bath and slashed her wrists. 

  1. What is the most likely differential diagnosis? 
  2. How would you manage this case?
  3. What medico-legal issues are likely to be involved here?

 

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