‫اذكرونا بدعوة‬

End-Block examination of Psychiatry

Group A
17/2/2022
Those are my own answers
--------------------------------------------------------------------------------------------

OSLER Exam :
 Video Link:
https://youtu.be/FGK-zisfHEE

 You have 15 minutes to answer the following Questions based on what you saw in
the video:-

1- What’s you provisional diagnosis.

- Post-traumatic stress disorder (PTSD)
2- If your professor told you to ask specific main -3- questions to the patient. What
would be those:
- I will ask about:
o Re-experiencing the event through intrusive recollection or
nightmares, reliving of the experience (flashbacks), or intense distress
when exposed to reminders of the event.
o Avoidance of thoughts or activities that may be reminders of the
trauma. Patient may have feelings of detachment (emotional
numbing), anhedonia, amnesia,
o Increased arousal persists after the traumatic event, which is
characterized by poor concentration, hypervigilance, exaggerated
startle response, insomnia, or irritability.
o I also mentioned that I will assess suicide risk.
 3- What’s you differential diagnosis:
- Acute stress disorder
- Generalized anxiety disorder
- Major depressive disorder
- Pathological grief
4- What’s your treatment.
- Combination of psychotherapy + anti-depressants.
- Psychotherapy: CBT
- Anti-depressants: SSRIs e.g. Fluxetine
------------------------------------------------------------------------------------------------------------------------

Theory Exam

 You have one hour (They gave us only 45 mins).

Question One:
A middle aged female with recurrent depressive disorder, with suicidal ideation and
moderate symptoms and failure to respond to treatment. The doctor decided to do
ECT.
Talk with the patient about what ECT treatment entails.
- I would like to tell the patient the following points:
- ECT is Electroconvulsive Therapy.
- It involves induction of generalized seizure.
- The duration of seizure is between 20 and 50 seconds.
- Patients usually receive a total of 4–12 treatments, given twice weekly
- There are two types:
o Modified (with anesthesia)
o Unmodified (without anesthesia)
- The exact mechanism is unknown, but it is thought to be complex including
neurotransmitter, hormonal release.
- Mortality Is rare about 2-3/100,000. usually due to cardiac complications
- Possible side effects:
o Temporary loss of short-term memory
o Temporary confusion
o Headache
o Occasional damage to the teeth, tongue, or lips and fracture may
occur (with unmodified ECT).
o Electrical burns
- I would like to exclude the relative contraindications:
o Serious Anaesthetic risk
o Recent MI
o Cardiac Arrhythmias
 o Cerebral Aneurysm
o Raised Intracranial Pressure
- The indications in this case include :
o Resistant depression
o Suicidal ideations
- I would like to prepare the patient for ECT in the following way:
o Taking detail Medical history
o Physical examination and Investigations.
o Taking Consent of the patient
o Check identity of patient.
o Fasting (8 hours)
o Empty bladder
o Check patient (not wearing rings, dentures)
o Stop drugs affect seizure threshold (e.g. benzodiazepine,
antiepileptics,)
o Ensure cleaning the site of electrode.
o Check ECT machine is working.

Question two:-
A man brought to the emergency by the ambulance. He had respiratory depression,
constricted pupils. He was stupor. He had grand-mal epilepsy.
Which of the following medications he mostly used in overdose? ( This question had 3 choices)
a. Coccain
b. Inhalants
c. Meperidine ✓✓✓

What’s your diagnostic evaluation.

- Ask the witness about other symptoms.
- Rapid recovery of consciousness following the administration of IV naloxone
(opiate antagonist) is consistent with opiate overdose.
- Urine and blood test remain positive for 12 to 36 hours.
How you treat.
- Ensure adequate airway, breathing and circulation.
- Administration of naloxone or naltrexone (opiate antagonist ) will:- Improve
respiratory depression // Rapid recovery of consciousness
- Oral methadone once daily, tapered over months to years.
- Psychotherapy.
- Support Groups.
Question Three:-
A man who live outside the city alone and doesn’t interact a lot with other people.
He is nor married and he didn’t attend the wedding of his sister. He is aloof. He has
no hallucination or delusion.
What’s your provisional diagnosis.
- Schizoid Personality Disorder
What’s the prevalence of the disorder in general population.
- Prevalence: (<1%)
Mention the features of that disorder.
- Aloof
- Keep a distance from social relationships (withdrawn & reserved).
- Few interests & pleasures in life, & takes pleasure in few activities.
- Lacks close friends aside from relatives
- Emotional coldness, detachment or flattened affect
- Little interest in sexual experiences.
- Chooses solitary activities
- Indifferent to praise or criticism but they do not secretly wish
for popularity.

Question Four.
Sarha travelled to a new town away from her home. She doesn’t remember anything about
her previous personality.
What’s the DDX with the most common diagnosis first.
- Dissociative Fugue
- Dissociative amnesia
- Multiple Personality Disorder
- Organic brain damage
- Substance abuse
What the most common form of treatment.
- Psychotherapy like CBT ?!!
Could this be conversion disorder. What are the shearing and difference features. ?!!!!
- ???

---------------------------------------------------------------------------------------------------------

- The END -