EOP GROUP D JANUARY 2018

Sbaq
1. 21y/o gentleman, cause disturbances by stripping naked on the road. Claim had contact with
alien thro telepathy. He can talk to god and god asks him to save the world. He had history of
admission into mental illness. Had history of taking opioids 3 weeks ago and urine showed
positive for opioids?
A． Delusional disorder
B． Schizotypal personality disorder
C． Substance induced psychotic disorder
D．Schizophrenia
E． Schizoaffective disorder

2. In the ward, he was given antipsychotic. He developed uprolling of eyes which he thinks is due
to alien control. He became upset and pace up and down in the ward.
Possible cause
A. Akathisia
B. Made action
C. Tic
D. Dystonia
E. Tremor

3. What is medication for the situation above in no.2

A. Setraline
B. Lorazepam
C. Procyclidine
D. Propanolol
E. Methadone

4. A 22 year old gentleman came to psychiatric clinic with persistently low mood. He started feeling
sad after failing his examination. He wasn’t able to feel happy and loss of interest. What is the
first line treatment for this patient ?
A. Setraline
B.

5. continue from the above situation-

After taking his medication,, the symptoms was gradually improved. He began to feel
energetic and stop taking the medication and his follow up.
3 weeks later, he was brought to psychiatric clinic by his family as he was very irritable and
he believed that his life was in danger as he was the reincarnation of mahatma gandhi. He
did not need any sleep and always posted in social media at night about "cure the world"
 What is the possible diagnosis?
A) Bipolar 1 disorder
B) Delusional disorder
C) Medication induced bipolar disorder
D) Medication induced psychosis
E) Schizoaffective
6.
7. A 34 y/o male smoker with persecutory delusion was irritable at home for the past 1 week.
He had decreased need of sleep and believed the FBI are spying him because he will
become the next president of America.
During the interview, he had rapid succession in speech, “My mother is very sweet to me,
but sometimes she gets angry. I never get angry because I love everyone but only my dogs
love me. Dogs are men’s best friend. Best friends are man. That man is the unity of the
nation”
After the interview, he was given IM haloperidol 10mg. A week later, he was restless and
unable to sit still.
Name the most likely provisional diagnosis
A. Bipolar I disorder with manic phase
B. Bipolar II disorder with hypomanic phase
C. Delusional disorder
D. Schizoaffective disorder
E. Brief psychotic disorder

8. What can you tell about his restless condition?

A. Dystonia
B. Akathisia
C. Made action
D. Tic
E. Drug craving

9. A 45y/o obese lady on oral hypoglycaemic agent came to psychiatric with complained of
depression 2 months. She also complained of poor sleep, loss of appetite, poor concentration.
She complained hearing multiple voices asked her to harm other people.
She was given medication during previous follow up and there was no improvement in her
symptoms and she had suicidal thought before.
A. Bipolar depression
B. MDD with psychotic features
C. Schizoaffective disorder
D. Schizophrenia w depression
E. Treatment resistant depression
10. Which one is the most likely treatment for the patient above :
A. Escitalopram and risperidone
B. Riaperidone and lorazepam
C. Olanzapine and lorazepam
D. Sertraline and olanzapine

11. Based on scenario in number 9, the patient currently has high suicidal thought in the ward, what
is your management?
A. continue the same medications
B. Start on ECT
C.start on with new SSRI
D. start on SNRI
12.
13. 18 years old college students keeps pulling hair whenever she feel stress. Part her scalp was
bald till she need to patch her hair. She was distress with her appearance however she could
not stop it.
She had history of pricking skin when she 12 years old.
A) body dysmophic disorder
B) excoriation disorder
C) somatic repetitive disorder
D) trichotillomania
E) Obsessive compulsive disorder (OCD)

14. A 28 years old female complained of feeling anxious during presentation since 11 months
ago. She will have palpitation, sweating and tremor and think that she had performed badly.
She keeps on worry and thinks about the next presentation. She afraid that these symptoms
will affect her performance at work.
What is the diagnosis of this patient?
A. Generalised anxiety disorder
B. Hyperthyroid
C. Panic disorder
D. OCD
E. Social anxiety disorder

15. A women 28 y/0, repeatedly brought her 2 months daughter to the emergency department
because she afraid she might harm by poisoning her baby with the milk that she prepared.
She also afraid that the babysitter also would poison the baby by milk. The thought has
been disturbing her that made her need to check her baby's condition repeatedly to feel
relieve. So, what is the likely diagnosis?
A.OCD
 B.illness anxiety disorder
C.GAD
D. Post partum psychosis
E. Munchausen syndrome by proxy

16. A 22 year old man has been isolated for the past one year. He believes that he is being
spied and though was inserted into his mind as an experiment. He also hears voices telling
him to harm others. He look perplexed and blank.
Which of the following suggestive for schizophrenia?
A. He is being spied
B. Thought was inserted into his mind
C. Isolated for the past one year
D. Hearing voices to harm others
E. Look perplexed and blank

17. A 19y/o collage girl overdosed with 20 pills of paracetamol because she argued her bf. She
deceitful to her bf and complained that he did not take care of her. She is envious with other
people stable relationships. She fears of being abandon.
A. Dependent personality disorder
B. Borderline personality disorder
C. Avoidant personality disorder
D. Antisocial personality disorder
E. Histrionic personality disorder.

18. The doctor asked the patient of what he did in his recent activities. The patient replied he went
out for an outdoor activity (?) but later found out, it didn’t happen and the event was displaced
over time.

What is the name of memory disorder ?

A. Confabulation
B. Tangentiality
C. Delusional memory
D.
E.

19. A lady came to clinic with crying & frustrated when she told she had a long standing medical
illnesses. She first had arthritis where she felt left knee joint pain and subsequently felt on the
other side. However, X-ray showed result was normal. Then she had left flank pain,
investigations showed no abnormalities. Patient persistently vomited however after endoscopy,
it showed mild inflammatory reaction of the lumen.
She came to you and said with a hopeful smile, “Nobody understands my illness. However, i
 heard u are the best doctor in town”.

20. What is the likely diagnosis ?

A. Illness anxiety disorder
B. GAD
C. Somatic symptom disorder
D. OCD
E. Factitious disorder

21. A 4yo girl, whose parents died one year ago, she was sent to foster institution. Due to the
poor environment, her uncle took her back and stayed with him. Recently, her uncle realized
that she has self-injuries. She also has poor eye contact, showed disliked when ppl touch
her, not joining with other children, had nightmares. She also had poor school performance
which the teacher noticed she had poor attention and poor motor coordination. Her IQ test
revealed borderline performance
A. PTSD
B. Autism
C. Borderline
D. Reactive attachment disorder

MEQ
1. 26y/o young guy who worked as a bank officer went to a company party. In the party, his
colleague gave him white powder and asked him to inhale. Since then, he continued to take the
substance and he became very euphoric, energetic and his work performance increased. He
started to think that his colleagues sabotage him because his was very sure that he will become
the next CEO in his company. Whenever he saw his colleagues talking at the corridor, he
believed that they were talking bad about him. His boss noticed that his work performance
started to deteriorate and he appear to be aggressive.

1. What is the substance he took? (1m)

2. List 4 side effects of the substance (2m)
3. Provisional diagnosis (2m)
4. List 2 psychopathology from the history (2m)
5. List 2 differential diagnosis (2m)
6. 3 weeks later, he was bought to emergency department because he was found to have a
bottle of ketene and he said he want to burn the office building.
Briefly discuss about the investigations (4m)
7. Briefly discuss about the management plan. (5m)
8. List 4 side effects of the biological treatment (2m)

2. A 58y/o gentleman came to psychiatric clinic due to persistently feeling sad and had suicidal
 thought since past 2 years. One day prior to his clinic visit, he had attempted to suicide by
jumping from 14th floor of his condominium. Recently, he had become more irritable and
argued with wife and want to divorce. His drinking habit had become worsen. Besides, he also
experienced poor sleep, poor appetite, weight loss, reduced sexual desire and poor
concentration. On the day of suicide, he waited until his wife went to work and left an apology
note.
He is a diabetic patient, however, he refused to take his medication recently because he said
“What is the point of taking medication if there is no future?” before this he had frequent
suicidal thought but no attempt. He currently smoke and drink heavily.
His wife believed that his stressor was due to his company bankrupt and he had a debt of
RM500,000. He wanted to end his life because he believed that after he passed away the
insurance money can help to support his wife and children financially.
1. Provisional diagnosis (1m)
2. DSM 5 criteria that support the diagnosis (5m)
3. List suicide risk for this patient (4m)
4. Briefly discuss about the management plan (8m)
5. What is the advice you want to give to his wife after discharge? (2m)

3. A 23 y/o gentleman who worked as an executive complained to his boss that he was harassed
and followed by a group of power individuals for the past 2 years. He can hear the group
constantly talking about him. He thinks that his family members and colleagues are also part of
the group by the way they smiled and nodded their heads. He isolated himself from his family
members and friends. He had poor insight. His boss said that his work performance had
dropped.
MSE revealed that he had blunting of affect, auditory hallucination. He was unkempt
1. Provisional diagnosis (2m)
2. DSM 5 criteria that support your provisional and relate it with examples (6m)
3. list the components of insight (3m)
4. Briefly discuss about the management plan (5m)
5. List the dopaminergic pathway and effect of each pathway (4m)

CLINICAL EXAM
Porta kabin (rabu) :
1. Lee - GAD (dr ruziana)
2. Ng - Schizophrenia (Prof Normala)
3. Edward - GAD with panic attack (Dr Noor Jan, Dr Beatrice)
4. GAD with panic disorder (Noor Jan and Beatrice)
5. Razali- Schizo
6. Lee - GAD w depression..kot HAHAHA (prof normala n siti irma)
7. Nur aiza( nama tak sure sgt)- MDD
8. Swee Weng- GAD and Panic disorder. ( dr ruziana)
HKL (rabu)
1. Pn Aisyah - Schizophrenia (dr nik) pt dtg lgi esok
2. En rajan - schizophrenia maybe have dysthymia (dr nik observe prof hamidin iv)
3. Cik Ada - bipolar 1 d/o currently in manic phase with psychotic feature (wad)

Hospital Kajang (Thursday)

1. Edward- GAD with panic attack (Dr Aaron and Dr Ruziana)
2. Rohana-Bipolar 1 in manic phase in psychotic features (dr Beatrice and Prof Firdaus)
3. Ng-schizophrenia (Prof Normala and Dr Irma)
4. MDD - pn shafura (dr beatrice and prof firdaus)
5. Bipolar 1 disorder - kuzaini (dr aaron, Dr ruziana)
6. Tx Resistant Schizophrenia w/ depressive sx (aizat, prof normala, dr irma)

HKL (Thursday)
1. dr ang / prof noor jan
a. Aisyah, tx resistant schizophrenia
b. - Yusoff, cannabis induced psychotic disorder
c. Rajan , schizo