Download University of Jaffna (University of Sri Lanka) MBBS (Bachelor of Medicine and Bachelor of Surgery) 2021 July Psychiatry Paper II Previous Question Paper
UNIVFRSITY OF JAFFNA, SRI LANKA
FINAL EXAMLNATION FOR MEDICAL DEGREES (2ND)
July 2021 Psychiatry Paper - II
Date: 30.07.2021
Time: 03 hours
ANSWER ALL SIX QUESTIONS
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.
1.1 List two differential diagnoses for the above presentation
(15 marks)
1.2 State three psychopathological features seen in this male
(15 marks)
1.3 Briefly describe the important areas in the assessment
(20 marks)
L4 Briefly discuss your first-line pharmacological management
(30 marks)
1.5 Mention how you would educate his parents
(20 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.
2.1 List three differential diagnoses you would consider in this patient
(20 marks)
2.2 Briefly describe how you would assess this patient
(30 marks)
2.3 Name two non-pharmacological management strategies useful in the treatment
this patient
(20 marks)
2.4 Describe how you would educate her on the symptoms she experiences
(20 marks)
2.5 State tw Q 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.
3.1 List three life threatening complications you would expect during the first 24
hours of admission
(15 marks)
3.2 Indicate, with reasons, five important investigations you would
order for this
patient
(20 marks)
3.3 Briefly discuss the pharmacological management you would plan for the next 48
hours
(30 marks)
3.4 Briefly describe how you would motivate him to change his alcohol related
behaviour
(20 marks)
3.5 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.
4.1 Identify five psychosocial issues of the woman mentioned in this narration
(20 marks)
4.2 Briefly discuss your management plan
(50 marks)
4.3 State the functions of jealousy in couple relationship
(30 marks)
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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.
5.1 State your provisional diagnosis with reasons
(20 marks)
5.2 List the salient mental state findings you would look for in this patient (20 marks)
5.3 Mention five risks this sales representative may have at present
(20 marks)
5.4 Briefly describe your management plan
(40 m arks)
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.
6.1 State the most likely diagnosis
(10 m arks)
6.2 Mention two clinical features that are suggestive of your diagnosis
(10 marks)
6.3 List four possible contributing factors for this child's problem
(20 marks)
6.4 Name two psychometric scales that are useful in the assessment of this child
(20 marks)
6.5 Briefly discuss the pharmacological management of this child
(20 marks)
6.6 Briefly describe the advice you would give the mother with regard to handling her
child's difficult behaviour
(2 Omarks)
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This post was last modified on 19 October 2021