Download University of Jaffna MBBS 2021 July Psychiatry Paper II Question Paper

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UNIVERSITY OF JAFFNA, SRI LANKA

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FINAL EXAMINATION FOR MEDICAL DEGREES (2ND)

July 2021 Psychiatry Paper - II

Date: 30.07.2021

Time: 03 hours

ANSWER ALL SIX QUESTIONS

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ANSWER EACH QUESTION IN SEPARATE ANSWER BOOK

1. A 25-year-old male was brought to the out patient department (OPD) as he had become irritable and was refusing food from his house for a period of one month. He was accusing his mother of adding urine into his food. On further questioning, he claimed that his real parents were related to the Queen of England. The current parents had kidnapped him and brought him to Sri Lanka, and were now trying to act as his real parents. He denied a history of substance use.

   1. List two differential diagnoses for the above presentation (15 marks)
   2. State three psychopathological features seen in this male (15 marks)
   3. Briefly describe the important areas in the assessment (20 marks)

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   4. Briefly discuss your first-line pharmacological management (20 marks)
   5. Mention how you would educate his parents (30 marks)

2. A 32-year-old bank assistant presented with sudden attacks of palpitations, sweating and difficulty in breathing over past several months. The symptoms intensified during the latter part of such attacks. She is married and is a mother of two children, aged 8 years and 6 years. She claimed that she has a supportive family and a pleasant working environment. Her repeated admissions to the medical ward revealed no major underlying pathology.

   1. List three differential diagnoses you would consider in this patient (20 marks)

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   2. Briefly describe how you would assess this patient (30 marks)
   3. Name two non-pharmacological management strategies useful in the treatment this patient (20 marks)
   4. Describe how you would educate her on the symptoms she experiences (20 marks)
   5. State two classes of medications with examples, which would be useful in the long term management of this patient (10 marks)

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3. A 43-year-old businessman was admitted to the psychiatric ward through the magistrate courts for the management of his problematic alcohol use. The history suggested that he had been consuming alcohol for more than 15 years, and recently his consumption had increased to the level of one bottle of arrack per day. He had frequent quarrels with his family and they usually ended up with wife-battering. On admission, he claimed that his last alcohol intake was 36 hours prior to the admission, and he suffered from insomnia in the previous night. He further revealed that he never had any hospital admissions in the past related to his alcohol use, and he never tried to abstain from alcohol before. He was found to be mildly agitated and his body was trembling.

   1. List three life threatening complications you would expect during the first 24 hours of admission (15 marks)
   2. Indicate, with reasons, five important investigations you would order for this patient (20 marks)
   3. Briefly discuss the pharmacological management you would plan for the next 48 hours (30 marks)
   4. Briefly describe how you would motivate him to change his alcohol related behaviour (20 marks)

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   5. Mention five offences related to alcohol use (15 marks)

4. A 27-years-old preschool teacher was admitted to the medical ward following ingestion of a handful of metformin tablets. When she was fairly stabilized following the initial management, the intern medical officer inquired about her problems. She revealed that six months back she had married a Canadian Tamil and had lived together for a month. However, after her husband returned to Canada, he started blaming her for her past affairs and suspected her present fidelity. She tried to explain her innocence, but failed. The day before the admission, her husband told her that he had withdrawn her sponsor application. She was in the medical ward for two days, during which she was found to be dull, weary, sad and tearful. She also had sleep problems. She showed no interest in her surroundings or in talking with the people around her. However, her self-care was good and she behaved well in the ward. She was able to develop a good relationship with the intern medical officer. On the third day of admission, she was referred to the mental health unit.

   1. Identify five psychosocial issues of the woman mentioned in this narration (20 marks)
   2. Briefly discuss your management plan (50 marks)

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   3. State the functions of jealousy in couple relationship (30 marks)

5. A 30-year-old sales representative presents himself to the psychiatry clinic with the complaints of poor sleep and difficulty in concentrating on his job for the past two months. The history revealed that he had survived a car crash six months back, in which he had lost his wife. He expressed that he had been frequently disturbed by the images of his wife, and at times he felt as if he was in the middle of the accident, still trapped within the car. These experiences were so unpleasant, and associated with intense feelings and strong emotions. He was found to be extremely distressed, and during the interview he told that he had a strong wish that he shouldn't have survived. He has started attending his job regularly but has been feeling lonely in the evenings.

   1. State your provisional diagnosis with reasons (20 marks)
   2. List the salient mental state findings you would look for in this patient (20 marks)

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   3. Mention five risks this sales representative may have at present (20 marks)
   4. Briefly describe your management plan (40 marks)

6. A 7-year-old boy is brought by his mother as she feels unable to cope with her child's behaviour. The boy is found to be very active and demanding, and it is often difficult to engage him in any activities even for a short time. According to the mother, the boy has been experiencing difficulty at school, finding it almost impossible to sit still in the classroom and frequently disrupting the learning activities. He has no friends at school because others feel that he is noisy and impatient during play activities. His mother states that since her husband is extremely strict with the child, she tries to compensate it by being kind.

   1. State the most likely diagnosis (10 marks)

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   2. Mention two clinical features that are suggestive of your diagnosis (10 marks)
   3. List four possible factors contributing to this child's problem (20 marks)
   4. Name two psychometric scales that are useful in the assessment of this child (20 marks)
   5. Briefly discuss the pharmacological management of this child (20 marks)
   6. Briefly describe the advice you would give the mother with regard to handling her child's difficult behaviour (20 marks)

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