Fellowship 2017:2_Psychiatry Question 1 A 44 year old man presents with “bizarre behaviour”. He was seen initially by the Mental Health Assessment Team who were concerned that his presentation may have an underlying organic cause. i) List 5 symptoms or signs that might suggest the presentation is more likely to be due to an underlying organic cause (5 marks) ii) List five (5) different categories of diagnosis, that can mimic psychiatric behavioural disturbances, for each type give a very specific example and an investigation that would be useful to prove that diagnosis. An example is given in the first row. (15 marks) Diagnosis Type (5 marks) Specific Diagnosis (5 marks) Investigation (5 marks) Metabolic Hypercalcaemia due to pancoast CMP/CXR tumour/PTHrp secretion Diagnosis Type Specific Diagnosis Investigation Sepsis Any source e.g.UTI Septic screen –BC/UA/MCS Head Injury Subdural, Concussion, SAH, Imaging – CT/MRI Extradural Toxic Serotonin syndrome, Drug levels/tox screen Carbamazepine OD SOL Any brain tumour, AVM CT/MRI Endocrine Thyroid Storm, Addisions crisis, TSH, cortisol Hypoxia/Hypercarbia Pneumonia, PE, hypoventilation Sats/ABG due to opiates, COPD exac etc Drug Induced Illicit drugs, prescription drugs SE, Urine drug screen, ECG, VBG intentional OD – as long as appropriate specific drug Neoplastic Brain tumour – primary or mets Imaging – CT/MRI Intracranial infection Encephalitis due to HSV LP Many other examples are appropriate. Must be different diagnosis types- cant be 2 marks for 2 endocrine causes Question 2
Fellowship 2017:2_Psychiatry Question 1 A 44 year old man presents with “bizarre behaviour”. He was seen initially by the Mental Health Assessment Team who were concerned that his presentation may have an underlying organic cause. i) List 5 symptoms or signs that might suggest the presentation is more likely to be due to an underlying organic cause (5 marks) ii) List five (5) different categories of diagnosis, that can mimic psychiatric behavioural disturbances, for each type give a very specific example and an investigation that would be useful to prove that diagnosis. An example is given in the first row. (15 marks) Diagnosis Type (5 marks) Specific Diagnosis (5 marks) Investigation (5 marks) Metabolic Hypercalcaemia due to pancoast tumour/PTHrp secretion CMP/CXR Diagnosis Type Specific Diagnosis Investigation Sepsis Any source e.g.UTI Septic screen –BC/UA/MCS Head Injury Subdural, Concussion, SAH, Extradural Imaging – CT/MRI Toxic Serotonin syndrome, Carbamazepine OD Drug levels/tox screen SOL Any brain tumour, AVM CT/MRI Endocrine Thyroid Storm, Addisions crisis, TSH, cortisol Hypoxia/Hypercarbia Pneumonia, PE, hypoventilation due to opiates, COPD exac etc Sats/ABG Drug Induced Illicit drugs, prescription drugs SE, intentional OD – as long as appropriate specific drug Urine drug screen, ECG, VBG Neoplastic Brain tumour – primary or mets Imaging – CT/MRI Intracranial infection Encephalitis due to HSV LP Many other examples are appropriate. Must be different diagnosis types- cant be 2 marks for 2 endocrine causes Question 2
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