PSYCHIATRY YEAR 4 END OF POSTING

GROUP B GENEZENS (2016/17)

MCQ

1.Regarding narcolepsy:
a. Automatism is absent
b. Diagnosis is based on nocturnal sleep polysomnography
c. Hypocretin deficiency
d. Characterised by sleep attack
e. REM sleep latency increase to 1.5 hours

2. Side effects of risperidone

a. Agranulocytosis
b. Hypertension
c. Sexual dysfunction
d. sedation
e. Increase blood prolactin

3. These are examples of disorganized speech in schizophrenia

A. Derailment
B. Flight of ideas
C. Looseness of association
D. Perseveration
E. Word salad

4. Based on acute stress disorder in DSM 5

a. Able to clearly remember the importants aspect of the traumatic events.
b. Outburst angry
c. Feeling estrangement from others
d. Flashback
e. Get nightmare bcoz watching movie

5. About gender dysphoria

a. Is due to androgen insensitivity (AIS)
b. post transition is one of the specifier in DSM 5
c. Insist that he/she is of other gender
d. dislike their sex anatomy
e. biological sex match with gender identity

6. Delusional disorder
a. Delusional perception is primary delusion
b. Othello delusion is pathological jealousy
c. against socio-economic background
d.
e.

7. Features of anxiety disorder

a. anticipatory anxiety
b.
c. Muscle tension
d. Laden paralysis
e. Alexythymia

8. These symptoms can be seen in major neurocognitive disorder

A. Catastrophic reaction
B. Confabulation
C. Prominent disorientation
D. Prominent long term memory loss
E. Psychotic symptoms

MCQ 9

The psychopathology commonly found in bipolar mania include

A) erotomania
B) delusion of control
C) flight of ideas
D) grandiose delusion
E) knight's move thinking

MCQ 10
Treatment for bipolar disorder
A. Graded exposure
B. Interpersonal social rhythm therapy
C.
D. Lamotrigine
E. Risperidone

SBAQ

1. Patient is a 16 year old girl. She has anorexia nervous. Which best fits her diagnosis?
A. BMI less than 16
B. Binge eating
C. Worry of being overweight
D. Think that she is fat though BMI shows is underweight.
E. Her worthiness depend on how thin she is

2. Mr. B, a 65y/o gentleman with u/l diabetes, hypertension, and hyperlipidemia. He had been an
occasional alcohol drinker of 50 unit weekly. He had no known paychiatric illness. One day his
daughter had brought him to the clinic because of he had "made up story". He had told the doctor of
what he had done in the morning but it was all untrue. Which is the most likely diagnosis for this
elderly man?
A. Alcohol use disorder
B. Malingering
C. Alzheimer's da
D. Substance induced major neurocognitive d/o
E. Substance induced psychotic disorder

3. At 8 years old boy is always on the go and has trouble waiting for turn. Writes 'b' as 'd' and scored
IQ test 68.
Mother claimed that he had no speech till 3 years old. Whenever he wants something, he would pull
his mother and point at the thing. He always plays with his toy cars and arranges them in a line. He
doesn't communicate to others much.
A) ADHD
B ) Autism
C) Intellectual disability
D)
E)
4. Madam X is admitted because she tried to kill her child.She was overwhelmed with motherhood
few months back when she started to feel depressed,..
Which is the best treatment for her?
A.
B.ECT
C.
D.
E.

5. Mr S was treated for schizoprenia. Her family members complained he can't sit still at home. What
would be your treatment?
A.Admit to ward
B.Benzhexol
C.discontinue the medication
D.muscle relaxant
E.propanolol

6. Miss S locked herself in room for one week and refused to talk with anyone. Which part of history
most suggestive of psychiatric illness?
A.blunted affect
B.lack of communication
C.no motivation to go to work
D.
E.talking to herself

7. Mr M was treated for chronic schizoprenia. In follow up, he was having involuntary, fine,repetitive
movement of the jaw. He was also having bilateral lower limb pain.MSE showed that he is anxious
and irritable.What best describe the condition)
A.akathisia
B.limb dystonia
C.parkinsonism
D.psychomotor agitation
E.tardive dyskinesia

Question 8-10 based on the scene below.

8. A 40 year old obese man was presented with sob, palpitation, chest pain and sweating. He also
feared that he might die due to heart attack.
He also feared going on public transport and needed company to bring him to hospital. Premorbidly
he was a constant worrier.

8) In the ED, what is the most important ix you would like to do.
A. Fbc
B. ABG
C. ECG
D. TFT
E. troponin T

9) What is his diagnosis

A. Agoraphobia
B. GAD
C. Panic attack
D. Panic disorder
E. illness anxiety disorder

10) what is the best tx of choice in ED

A. Propranolol
B. Diazepam
C. Breathing exercise
D.
E. Sertaline

Meq 1

38 yo ex army came in for therapy.In the initial,when asked to talk about his problem,he got rage and
angry.He said he was the only survivor of mortar attacks by enemy.He avoids watching television
show on wars and avoid thinking about it. He also take morphine to help with nightmares and
screaming upon awakening. He would be startled with loud noise and had panic attacks. He took
some length to avoid thinking about it. He also told he had no feelings at all and he said "I'm
worthless, I have no wife,no kids and nothing'.
1. What is the diagnosis (1m)
2. Give 5 clinical features patient has (5m)
3. Treatment for this patient (6m)
4. Give 3 risk factors to developing this illness (3m)
5. Give 4 withdrawal symptons of morphine (2m)

MEQ 2

40y/o lady, presented to ED complained of worms all over her body. Started 2 years ago where she
alleged saw worms in her menses, and started to fell worms moving all over her bowels and lower
limbs. Her symptoms worsened 1 year ago, she constantly having headache and insomnia, she
believed the worms had migrated to the brain and eat her brain. Otherwise still able to go to work
and socialise with friends. Blood and radiological investigations were insignificant.

A) 2 psychopathology and define (4m)

B) provisional diagnosis (2m)
C) two differentials (2m)
D) features to rule out differentials (4m)
E) treatments (6m)
F) 2 side effects of the medication above (2m)

MEQ 3

Father complained that his son , a 16 year old boy had change in behaviour for past 6 months. In
school , he has not been passing up his homework. He often erases his answers only to rewrite the
same answer. He claims that he has this urge to write neatly and will continue to do so till it is "just
perfect". He denied of hallucination or change in mood.

A) what is the provisional diagnosis (2m)

B) explain 2 clinical features (4m)
C) 2 other themes of the above disorder (2m)
D) state 2 classes of drug that is used, the example and 2 side effects of each (8m)
E) explain about the psychotherapy used (4m)
Long case

Venue Examiner Case

Kajang Dr Aron 1. GAD- edward
2. Panic disorder wf gad -muhd hafizal
3. fikri - schizophrenia currently on partial remission
4. MDD in full remission -mr.tan (pt ada hx suicidal intent 2x n
hypothyroid dx awal tahun ni)
Dr Beatrise 1. Fikri-Schizophrenia multiple episode currently in partial remission
2. lai see wong- gad with panic attack
3. edward: GAD with panic attack
4. Rafsan- panic disorder
Dr Ruzi 1. Gad - edward
2. Bipolar 2 d/o in hypomanic state
3. schizophrenia with partial remission
Dr Ang 1. Panic disorder comorbid mdd (tapi dr kata dia specific phobia
😂)
2. GAD comorbid PD-edward
Prof Norjan 1. MDD with panic attack
2. GAD with panic attack (lai)

HKL Prof Norjan 1. Schizophrenia, never been admitted. Absah

2. Bipolar 1 disorder most recent episode manic currently in full
remission. ( this patient said she coming HKL again tomorrow-
kusrina)
Dr Nik 1. Schizophreniform 1st admission. Thay (vietnamese)
2. Schizoprenia for 20 yrs, multiple episode. Ng
3. bipolar 1 currently in manic phase . pt ward
4. bipolar 1 current manic - mr zainon
Dr Chong 1. schizophrenia (rajan)
2. bipolar 1 disorder (absah
Prof Hamidin 1. bipolar 1 disorder (kuzini)
2. bipolar 1 disorder
3. meth induce psychotic do (inpatient