MD Psychiatry Exam - September 2022 PDF

## **POSTGRADUATE INSTITUTE OF MEDICINE** ## **UNIVERSITY OF COLOMBO** ## **MD (PSYCHIATRY) EXAMINATION – SEPTEMBER 2022** ### **Date:- 20th September 2022** ### **Time:- 9.00 a.m. – 12.00 noon** ## **STRUCTURED ESSAY PAPER** Answer all ten (10) questions. Each question to be answered in a separate...

## **POSTGRADUATE INSTITUTE OF MEDICINE** ## **UNIVERSITY OF COLOMBO** ## **MD (PSYCHIATRY) EXAMINATION – SEPTEMBER 2022** ### **Date:- 20th September 2022** ### **Time:- 9.00 a.m. – 12.00 noon** ## **STRUCTURED ESSAY PAPER** Answer all ten (10) questions. Each question to be answered in a separate book. ### **1.** A 60-year old retired school teacher was brought by her son with a history of depressive symptoms such as poor sleep, poor appetite, lethargy and low mood for two weeks duration. In addition, the son reported that she had intermittent confusion for the past one week duration. She has been diagnosed with bipolar affective disorder for the last 10 years. She lives alone and has been stable for the last one year on sertraline 150 mg mane and sodium valproate 200 mg nocte. She has also been on treatment for diabetes, hypertension and ischemic heart disease. ### **1.1.** What is the most likely reason for the current clinical presentation? **(10 marks)** ### **1.2.** Outline the assessment of this patient. **(40 marks)** ### **1.3.** Her son insists that she be given ECT as she responded well to ECT 10 years back. Briefly mention the pros and cons of giving ECT to this patient. **(50 marks)** ### **2.** You are the acting psychiatrist at a district general hospital which does not have an inpatient psychiatry unit. You receive a referral from a medical ward that a patient has been brought in off the streets by a 1990 ambulance due to residents of the area complaining about his wandering behaviour. All medical investigations including CT scan brain are normal. The patient is a young man and appears severely dishevelled. He is not disturbed or aggressive but only speaks a few words which are not rational. He is noted to be smiling to self at times and spends large periods staring into space. He eats if food is given to him and his sleep is normal. You make a tentative diagnosis of schizophrenia. The medical ward wishes to discharge the patient. ### **2.1.** List the areas of concern in this patient. **(20 marks)** ### **2.2.** Outline how you would practically manage each of the concerns stated above. **(40 marks)** ### **2.3.** Briefly discuss the ethical issues involved in the management of this patient. **(40 marks)** ### **3.** A 21-year-old female who is doing a course in psychology in a private university has been brought to the out-patients department following an overdose of 10 tablets amitryptylin, which is used by her grand mother. She has a history of several previous self-harm attempts over a period of three years usually associated with relationship issues. She has brief but intense relationships which lead to anger and mood fluctuations. Despite the above she continues her studies and socializes often. ### **3.1.** State the most probable diagnosis of this patient. **(10 marks)** ### **3.2.** Give reasons for arriving at the above diagnosis in terms of ICD 10 diagnostic criteria. **(40 marks)** ### **3.3.** Outline the management of this patient. **(50 marks)** ### **4.** You are the psychiatrist at a district general hospital. During your weekly clinic, you are informed that a 65-year-old female patient, who was on treatment for bipolar affective disorder from your psychiatry clinic for the past 6 years, has died by hanging three days ago. You have seen the patient several times in the past, both in the clinic and as an in-patient. The patient's last clinic visit had been three months ago. The clinic nurse informs you that the deceased patient's daughter has now come to the clinic and is asking to meet you. ### **4.1.** Outline the important aspects of your discussion with the daughter. **(40 marks)** ### **4.2.** The daughter requests that you attend the funeral. How will you respond? Give reasons. **(30 marks)** ### **4.3.** During the first few days after learning about the suicide, you have difficulty in sleeping. You worry that you have failed in duty of care towards the patient. How would you manage this situation? **(30 marks)** ### **5.** A 9-year-old school boy was brought by his parents after he tried to run away from his home two days before. He had become aggressive and oppositional towards his father after his mother attempted suicide two weeks ago. He is the only child of a businessman. His mother had quit her job as her husband had morbid jealousy. The child had witnessed domestic violence over the years. The father has taken treatment from a psychiatrist intermittently and has alcohol dependence syndrome. ### **5.1.** Explain the possible reasons for the child's behaviour. **(20 marks)** ### **5.2.** List the long-term psychological effects on the child. **(40 marks)** ### **5.3.** Briefly discuss the principles of management. **(40 marks)** ### **6.** A 24-year-old male is referred to you by a maxillofacial surgeon. The referral mentions that the patient had undergone surgery for correction of a protruding jaw. However, the surgeon is concerned that the patient is requesting other facial surgeries which are not indicated. On further inquiry, the patient reveals that he has been unhappy about several aspects of his face since his teenage years. He has avoided direct contact with people due to these concerns. This has significantly affected his studies and employment. He has seen several doctors over the last few years requesting plastic surgery. ### **6.1.** Give the two (02) main differential diagnoses in this patient. **(20 marks)** ### **6.2.** Briefly describe the aspects of the mental state examination that will help to arrive at a diagnosis. **(40 marks)** ### **6.3.** Outline the psychological management of the most likely diagnosis in this patient. **(40 marks)** ### **7.** You are called to see a 28-year-old mother in the postnatal ward. She had delivered her second baby at term by normal vaginal delivery about two hours ago. The only information the ward staff can provide is that she is living with her 68-year-old grandmother. The father of this baby is currently serving a prison sentence. The intern house officer tells you that the patient revealed that she has been using heroin on a daily basis for the last five years. ### **7.1.** List the problems you anticipate in this situation. **(40 marks)** ### **7.2.** Briefly discuss the management of the above patient in the Sri Lankan context. **(60 marks)** ### **8.** A 68-year-old mother of two married daughters is brought to you by her husband. The husband says she is confused in the evenings and sees imaginary children playing in the garden. She gets angry and shouts at them asking them to go away and not destroy her plants. Apart from this behaviour, she is normal during the day. She does all the housework including the cooking and cleaning. He has noticed occasional forgetfulness, but it is not so marked. She does not have any medical issues. Her physical examination is normal apart from some unsteadiness and slowness while walking. On cognitive assessment, her MMSE is 23/30. The main deficits are in serial sevens test and recall which is 1/3. The blood investigations including FBC, ESR, CRP, LFT, TSH, RFT and HbA1C are within the normal range. Her MRI scan of the brain is normal and there is no evidence of atrophy of the brain. ### **8.1.** What is the most probable diagnosis? **(10 marks)** ### **8.2.** Briefly state the diagnostic criteria for the above diagnosis. **(50 marks)** ### **8.3.** If you are in a developed setting what is the investigation that will confirm the diagnosis. **(10 marks)** ### **8.4.** Briefly outline the initial pharmacological approach to the management of this patient giving reasons. **(30 marks)** ### **9.** ### **9.1.** What is evidence-based practice? **(40 marks)** ### **9.2.** Discuss the limitations in this approach. **(60 marks)** ### **10.** Briefly describe the role of the psychiatrist and the medico-legal considerations in the following circumstances. ### **10.1.** The director of a teaching hospital refers a male intern medical officer who has been accused of photographing a female intern medical officer in the changing room of the operating theatre. **(50 marks)** ### **10.2.** The court refers you a male who had allegedly assaulted his wife while under the influence of alcohol. The wife had succumbed to the injuries. **(50 marks)** ## **POSTGRADUATE INSTITUTE OF MEDICINE** ## **UNIVERSITY OF COLOMBO** ## **MD (PSYCHIATRY) EXAMINATION – SEPTEMBER 2022** ### **Date:- 20th September 2022** ### **Time:- 2.00 p.m. – 3.00 p.m.** ## **ESSAY PAPER** Answer only one (01) out of three (03) questions. ### **1.** Religion and spiritual practices have helped people cope with the economic crisis in Sri Lanka. Critically discuss. ### **2.** The existing mental health laws in Sri Lanka are not in line with current psychiatric practice in Sri Lanka. Critically discuss. ### **3.** Sri Lanka should develop its local guidelines instead of relying on western guidelines for the treatment of psychiatric disorders. Critically discuss.