2. CBLE Consultation Liaison

Consultation liaison Psychiatry

1. A 40-year old woman has been on disodium evaporate for her bipolar disorder suddenly developed acute abdominal pain and vomiting, and is brought to intensive care unit in a semi-comatose state.
a)What will be your role as a management team member in assessing and managing the case? 5
b)What advice will you provide if she recovers from the present condition and during leaving hospital?  5

2. A 30-year old man who is getting antipsychotics for his schizophrenia admitted in emergency with the complaints of rigidity, hyperthermia, autonomic immobility and confusion. For these, he got psychiatric referral.
a) What diagnosis you will write? What are the first line biochemical tests you need to be checked or suggested? 6
b) What major steps of management plan you will share with the management team?  4

3. A 30-year old woman who is getting imipramine for her depression admitted in the intensive care unit for overdosing with the medication. She is stuporus with unstable heart rate. You are requested to see this patient.
a) How will you explain the case to your referring colleague? 5
b) What major steps of management plan you will share with the management team?  5

4. A 34-year old man presents with passage of mucus with stool, fullness of the abdomen. He tells that he has “gastric” and “dysentery” that persist since 10 years despite of several treatments. All investigations revels no abnormality. He looks anxious and depressed and surprises that he referred to psychiatry.
a) What could be differential diagnosis? 4
b) Make a checklist of your assessment areas to reach a diagnosis. 6

5. A 56-year old woman with long history of Bipolar disorder who admitted in the University hospital for electrolyte imbalance and subsequently that was corrected. She also has hypertension, renal impairment and receiving treatment. Recently, she appears with fluctuating confusion, excessive talkativeness, restless, insomnia, and occasional excitement. For that reason she has been referred for psychiatric consultation.
a) How will you proceed to assess this case? 5
b) What investigations are required at this stage? 5

6. A 60-year old male admitted for his uncontrolled diabetes. He frequently takes high dose of insulin beyond the prescription that caused hypoglycaemic state in several occasions since last 4 months. In some occasions, he takes excessive food after overdosing of insulin in any ways. For these odd behaviours, the consultant refers him for psychiatric evaluation.
a) What will be your differential diagnoses?  6
b) Outline your assessment plan. 4

7. A 27-year old man admitted to cardiology department complaining of severe chest pain. He reports tenderness during auscultation and dizziness. All form of cardiac examination is unable to explore any underlying cause for his pain. The medical record shows that this is the third time in the past three years he appeared medical help always at the end of Eid festival. On each previous occasion, no identifiable medical problem could be uncovered. Now, this person is referred for psychiatric evaluation.
a) What will be most likely preliminary diagnosis? 6
b) What are the areas you need to assess?   4

8. A 60-year old male patient with CRF referred to you. He was depressed during admission. Later, he developed irrelevant talks, excitement, violent behavior, sleep disturbances and loss of appetite.
a) What areas you need to assess? 4
b) What are the differential diagnoses? 3
c) What could be the management plan? 3

9. A 30-year old male patient in medicine OPD refuses to provide answers during initiating history taking like address, family information. When asked the reason for the refusal, he replies he does not see why the physician needs such irrelevant information and watches the physicians suspiciously. When pressed further, he asks angrily, “Are you going to treat me or my family? Should I complain to the authority?” The surprised physician discussed the matter to you.
a) What is the most possible diagnosis? 4
b) What strategies you will adopt to advocate the physicians to assess and manage such case? 6

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