Psychiatry Exam questions

Dear Colleague, Imagine the

The Psychiatry Board Exam is on the difficult side, with a pass rate dipping as low as 75%. Additionally the new board exam has a section of video vignettes/cases that are a new format. It’s important to train on these types of questions to understand the pacing of the content as well the difficulty level. Below are sample Psychiatry Board Questions. We suggest using question banks to reinforce concepts and engage with simulated test conditions.

Question 1. Substance Related Disorders QID 32929

You are seeing a 68-year old woman with a history of chronic alcohol abuse in the ED. She presents with confusion. On exam, she is tachycardic, hypothermic, and has an ataxic gait with foot weakness, and foot drop. What is the most likely diagnosis?

A. Wernicke’s encephalopathy
B. Korsakoff’s syndrome
C. Alcoholic hallucinosis
D. Delirium tremens
E. Alcohol intoxication

Answer: A. Wernicke’s encephalopathy.

Explanation:

Wernicke’s presents with neurological symptoms caused by biochemical lesions of the central nervous system after exhaustion of thiamine (vitamin B1) reserves. The classical presentation of Wernicke’s encephalopathy is characterised by the triad of: ophthalmoplegia, ataxia, and confusion but only 10% of patients exhibit all three features. Other symptoms include: hypothermia, hypotension, peripheral neuropathy, weakness, amnesia, hyperhidrosis, foot drop, and decreased proprioception.

Korsakoff’s usually presents with amnesia, confabulation, apathy.

Alcoholic hallucinosis involves auditory and visual hallucinations, usually accusatory or threatening ones. It can occur during acute intoxication or withdrawal from alcohol.

Question 2. Mood Disorders QID 14255

A 19 year-old patient presented with his first manic episode and was started on lithium. Day two into his admission he experiences motor excitement, mutism and stereotypic movements. Lorazepam was trialed for two days and was not effective. What is the next best treatment?

A. Atypical antipsychotic
B. Increase the lithium dose
C. ECT
D. Switch to valproate
E. Discontinue all medications and start IV fluids only

Answer: C. ECT.

Up to one third of manic patients will develop catatonic features as described by negativism, withdrawal, staring, immobility/stupor, mutism, posturing, grimacing, stereotypies, mannerisms to non-purposeful excitement, undirected combativeness, unexplained impulsive behavior, echopraxia and echolaliamotor excitement, bizarre grimacing, and waxy flexibility (among others). Per the DSM-5, at least three of the above-mentioned manifestations must be present to include a catatonia specifier.

There is a stong evidence-basis for treatment with Lorazepam and ECT. Patients generally respond well to benzodiazepines with lorazepam having the most evidence. If there is not a good response, ECT should be strongly considered as it is an effective treatment for catatonia.

When the diagnosis of catatonia has been made, the use of antipsychotic and/or antidepressant medications should generally be avoided. Antipsychotics can worsen catatonia due to parkinsonian side effects and can increase the risk for neuroleptic malignant syndrome. A change in mood stabilizer dose or a change to another mood stabilizer has not been shown to be an effective treatment in catatonia.

Reference:
Catatonia in a patient with bipolar disorder type I J Neurosci Rural Pract. (2014) Jul-Sep; 5(3): 314–316. American Psychiatric Association. (2005). American Psychiatric Association practice guidelines. Practice Guidelines for the Treatment of Patients with Bipolar Disorder. Arlington, VA: American Psychiatric Publishing.

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Q&A

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How do i sue a hospital that held me for psychiatric evaluation against my will and ny mental hygeine laws?

iI realize that you're very distraught, and it sounds like you have a right to be. I'd suggest that you contact an attorney who specializes in mental health (which really is a complicated field), who can obtain all of your files and, if necessary, have them reviewed by a psychiatrist retained on your behalf. Depending on the review, and the advise of your attorney, you'll be advised how to proceed.

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