2020-06-29
163
# 91
*! A 32-year-old patient is agitated, disinhibited for the last 3 weeks, makes immodest compliments to female colleagues, constantly smiles, jokes. He urges everyone to invest in network marketing, in which he recently signed up, promises huge profits and benefits, says that he himself is incredibly “getting rich”. In recent days, he practically does not sleep, became irritable, conflicts with employees, said that he quits after he was made a remark. He began to upload his everyday videos on instagram, facebook, where he takes pictures of himself up to several dozens of times during the day.
Which of the following diagnoses is MOST probable?
Schizoaffective disorder or manic psychosis?
# 92
*! Teenage girl, 16 years old. At a reception with a psychiatrist accompanied by her mother, she complains of a depressed mood, fatigue, difficulty concentrating, inability to cope with homework, a feeling of “dullness”, insolvency ”in the classroom,“ the world seems bleak ”, crying, said that“ she lost interest in communication, to friends... although everything was fine before... I don’t want to talk to anyone... it seems that life does not make sense... ” It looks sad, movements and speech are slowed down, appetite is lowered, falls asleep late, sleeps 5 hours a day. This condition lasts more than 3 weeks, appeared for no apparent reason; a year ago, there was also a bad mood for no apparent reason, but after 3 weeks the condition spontaneously improved.
Determine the MOST probable probable diagnosis?
Depressive psychosis
# 93
*! Patient, 45 years old. I turned to the clinic with complaints of low mood, unreasonable anxiety, anxiety, tearfulness, night sleep disturbance for 3 weeks. For the first time, such a condition was noted 6 years ago, which periodically resumed without external causes. After the 4th hospitalization and discharge from a psychiatric hospital, the mood was stable throughout the year, took maintenance therapy: antidepressants, normotics. The condition worsened after discontinuation of the drugs, as against their background marked dry mouth, increased appetite, and gained weight. At the reception: Sits in a sad pose, sad expression, corners of lips lowered, answers questions after a pause, laconic, feels guilty before her husband, as she has stopped doing homework, constantly feels “tired”, expresses passive suicidal thoughts: “fall asleep and not wake up, ”the appetite is reduced, she lost 4 kg in a month.
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Which of the following diagnoses is MOST probable?
Depressive psychosis
# 94
*! 40 year old patient turns to the clinic, accompanied by his sister, indicating fatigue, sleep disturbance, weakness, suicidal thoughts, tried to hang himself. From the anamnesis of life: in premorbid without features. Married, has two children. A year ago, the opposite state was noted, when the mood suddenly increased, he was active, sociable, active, expressed many ideas, took 3 loans in the bank, subsequently could not pay off, this condition lasted about 2 months, then became conflict, quarreled with his wife, decided to live separately. He works as an entrepreneur, does not use drugs, alcohol. In the mental status: it looks sad, the eyelids are lowered, motor is inhibited, unproductive, does not show interest in the conversation, speaks in a muffled voice, monosyllabic answers, after a long pause, there is no sense of vitality, there is no appetite, speaks of unwillingness to live. He said that he felt especially bad in the morning, could not get out of bed, felt heavy in the body, "as if his back were glued to the bed."
Which of the following diagnoses is most likely?
MDP, bipolar disorder
# 95
*! A patient of 18 years old, a citizen of Kazakhstan, was deported from the United States, where she studied at the college for a year. Her condition changed within 2 weeks, for the first time in her life: she became overly active, active, violated academic discipline, began to dress vulgarly, used excessive makeup, became talkative, reckless, laughed and sang in the classroom, once came to college with alcohol, which offered to drink with the teachers, did not respond to comments, conflicted. According to her father, she was sleeping on the plane, as she took medications prescribed by a psychiatrist. Upon arrival, for 2 days I was cheerful, active, did not sleep at night, laughed, called endlessly to my classmates, tried to go to a nightclub, jumped on the couch, danced, cursed with parents who made comments. In mental status: she looks cheerful, lively, actively gestures, speech is accelerated, asks new questions, without waiting for answers, jumps from one topic to another, compliments the doctor, believes that her parents do not understand her.
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Which of the following diagnoses is most likely?
Manic psychosis
# 96
*! Teenage boy, 15 years old. Heredity is burdened by uncle schizophrenia. Brought up in a complete family. For about a month, my mood decreased, he said that he had ceased to understand school subjects, “he became like oligophrenic”, “I don’t remember anything, as if I don’t know the answers to simple questions - even 2 + 2.” It seems that "others will laugh at me, they will see how stupid I am," so she does not want to go to school. There was a feeling of apathy, hopelessness, expresses suicidal thoughts.
What is the most likely syndromic diagnosis?
Children's schizophrenia?
# 97
*! After what time period of antidepressant use is it necessary to evaluate its clinical effectiveness?
2-3 weeks
# 98
*! A 30-year-old patient became depressed, inhibited for a month, complains of chest tightness, anxiety, suicidal thoughts. Which of the following drugs from the antidepressant group is MOST indicated?
TCA - pyrozidol, befol
SSRIs-fluoxetine, sertraline, paxil (the safest among antidepressants)
# 99
*! Patient 40 years old, suffering from bipolar affective disorder. He was in a psychiatric hospital in connection with a severe depressive episode without psychotic symptoms. After a course of therapy in a mental state, intermission was achieved. Which of the following drugs is MOST indicated for maintenance therapy after discharge?
Lithium carbonate
#100
*! A 25 year old patient suffering from bipolar affective disorder. She was in a psychiatric hospital in connection with a moderate episode of mania. After a course of therapy in a mental state, intermission was achieved. Which of the following drugs is MOST indicated for maintenance therapy after discharge from the department?
Lithium carbonate
# 101
*! The patient is 20 years old, enters the hospital in a state of pronounced joyful excitement. According to his parents, he strives for numerous contacts, acquaintances, runs away from home to parties, laughs loudly, jokes, conflicts with his parents, claims that they are home-stayers, old-fashioned, and she is a modern and advanced personality. He does not sleep at night. Which of the following drugs is MOST indicated for the relief of manic arousal?
Relanium
Antipsychotics
# 102
*! Man, 26 years old. He entered a psychiatric hospital for the first time. Looks joyful, active, sociable, expresses the idea of revaluing his own personality. Declares that he is "the only heir to millions of father, the continuer of the surname, a talented scientist."
What type of psychopharmacotherapy is MOST indicated for this patient?
Antipsychotics
# 103
*! A 27-year-old man is undergoing treatment for recurring outbreaks of anger and aggressiveness as part of manic arousal.
What therapy is MOST appropriate for the patient?
Sedative
# 104
*! Woman, 30 years old, married, two children, housewife. I went to the clinic complaining of a bad mood, lack of appetite, impulse to something, fatigue, poor sleep. The condition changed within a month, for no apparent reason. She began to cope with household chores with difficulty, “I want to constantly lie down”, “I don’t want to take care of myself”, “I don’t want to communicate”, thoughts about my insolvency, uselessness, self-esteem decreased, considers myself “a bad wife and mother”, suicidal thoughts not expressing, actively seeking help. Passed examination: FG, ECG, laboratory data without pathology. Somatically healthy.
What is the most preferred diagnosis and tactics of a GP doctor in accordance with the Psychiatric Care Standards in the Republic of Kazakhstan?
Depression, tactics?
# 105
*! The patient is 39 years old, the last 2 months he is excited, disinhibited, makes immodest compliments to women, constantly smiles, jokes, swears, obscene. At the reception: Pupils are narrow, do not respond to light. Mistakes in the simplest account. Incorrectly names the date and month. He does not consider himself sick.
To clarify the diagnosis, it is most important to carry out:
Wasserman reaction
# 106
*! 2nd year student, 18 years old. At the doctor’s appointment, accompanied by the mother. Looks bleak, drooping, face hypomymic, speech slowed down. The condition has changed over the course of a month. He said that he “lost the meaning of life”, “complexes appeared”, “I don’t want to talk with anyone”, “I stopped talking to fellow students” because I don’t want to burden them with my problems, “although I don’t understand my problems and don’t understand, what happened - no one died, did not get sick, and I - physically completely healthy... but hard on my soul... I was always an activist, cheerful, sociable... there were many goals, daily, monthly plans, which I always fulfilled... and here... everything collapsed - I can’t do anything... I sit or spend all day in bed... I don’t even have thoughts in my head... I don’t know how to live on... I feel bad, worthless... I am ashamed in front of my mother that I do not live up to her hopes... because I am the only support for her... it seems that I can’t even kill myself... "
What is the most preferred diagnosis and tactics of a GP doctor in accordance with the Psychiatric Care Standards in the Republic of Kazakhstan?
Depression, tactics?
# 107
*! Man, 25 years old. He was brought to the clinic by relatives due to the fact that he tried to make a suicidal attempt by self-hanging. At the reception, he speaks of his sinfulness, guilt for "wrong actions" that he committed as a teenager, "when he studied at the Olympic reserve school - then they hooliganized with the guys, secretly from the teachers - smoked, drank alcohol." He sits with lowered eyes, because "it’s a shame to look people in the eyes," he believes that he is not worthy to live on, that he must die. On the first day of hospitalization in a psychiatric hospital, he tried to drown himself in the sink, covering the sewer with his toe, the next day he tried to suffocate himself with his shirt sleeve. From the anamnesis: Heredity is not burdened, lives with parents. Earlier, short-term (up to a week) opposite states were noted, when he became cheerful, active, active, made many plans, joked a lot.
What is your medical tactic after diagnosing a mental condition?
Depressive-delusional syndrome, tactics?
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# 108
*! Woman, 35 years old. At the reception, accompanied by spouse and mother. From the anamnesis: married, has three children, a housewife, family relationships are good. The condition has changed for the first time, for no apparent reason. The patient looks wilted, the expression on her face mournful, sitting in a dull pose. Speech and motor skills are slow, responding after pauses, in a low voice. She said that “... she is bad at heart, pleases nothing, has no desires, has no appetite... she has lost 4 kg in a month... I feel unnecessary, guilty, I can’t do anything, the children have stopped pleasing... I don’t want to live, I constantly think about suicide although I know that I can’t - I have children, and this is a sin. ”
What is your medical tactic as a GP doctor in accordance with the Standards for the provision of psychiatric care in the Republic of Kazakhstan?
Depression, tactics?
# 109
*! A man, 63 years old, suffered a series of psycho-traumatic events: “sent to retire”, “lost two friends in a year - former classmates with whom he spoke closely”, “his wife suffered a hip fracture - she was afraid she would die”. The local therapist said that “there is no sleep, no mood, she feels constant tiredness, I constantly want to cry... there is no desire to do anything, there is a sense of hopelessness, meaninglessness of life...”. It looks sad, shoulders are lowered, motor is somewhat inhibited, slow thinking.
What is your medical tactic after diagnosing a mental condition?
Reactive depression, tactics?
# 110
*! Patient, 40 years old. Delivered with his brother. Complaints of bad mood, sleep disturbance, bad thoughts, fear of punishment, dry mouth, constipation. From the anamnesis: married, has 4 children, works as a driver. Mental state: Sits in a sad position, with a sad and tense expression on his face, lowered eyes. In the conversation, formal, not interested. Answers in a low voice, in slow motion, monosyllables, after pauses. The mood is lowered, he admitted that he feels shame and fear of punishment for wrong actions that he can’t talk about. He blames himself for not being able to perform namaz, although he is a believer, I am sure that this is a great sin, and therefore thinks of suicide. Periodically hears the sound of his thoughts, accusing character. Appetite is sharply reduced, motor inhibition. Somatic and neurological pathology was not detected.
What is your medical tactic as a GP doctor in accordance with the Standards for the provision of psychiatric care in the Republic of Kazakhstan?
Depression, tactics?
# 111
*! A 24-year-old man complains of an obsessive fear of increased pressure and sudden death from a stroke. The first fear arose 6 months ago during a physical examination, when he was informed of an increase in blood pressure to 160/100 mm Hg. Since then, the fear of death from a stroke is constantly present in the mind, during the week periodically there are attacks of anxiety for one’s health, the fear of death, which is why it is constantly examined by interns, often causes an ambulance team, and quits work.
Which of the following disorders is MOST likely?
Thanatophobia
# 112
*! After the tragic event, as a result of which the woman’s own summer house burned down, she was unable to move, answer questions, and inability to take any action within a few hours. Recovering, she did not remember that she had witnessed the fire.
Which of the following mental disorders is MOST likely?
