Psychiatry (damn and accursed) examination only MIR
Tuesday, February 1, 2011
Isabella Soprano Compilation
Within MIR 2.0 initiative, which we heard on the blog Becoming Pokémon Trainer, collect the answer, commented, from questions of Psychiatry MIR examination this year. The rest (answered in a much more witty and interesting) in the blog of our colleague and friend Miguel called pitiusa Psychiatry.
142. Which of the following statements is NOT TRUE for bipolar disorder?
1. It comes with a succession of depressive and manic phases, although they may appear normal ranges.
2. ECT (electroconvulsive therapy) is indicated in bipolar disorder treatment in cases of severe mania or refractory.
3. Inheritance supported in bipolar disorder is an autosomal dominant trait with incomplete penetrance.
4. The treatment of bipolar disorder with lithium carbonate is indicated both for a manic and prophylactic treatment.
5. The presence of delusions exclude a diagnosis of bipolar disorder.
1 option is totally true.
The 2 is also correct, is not the primary indication for ECT (which would be the depressive phases or major depression), but there is no such indication.
The 3 is false. It admitted the presence of important genetic factors in the inheritance of bipolar disorder, but certainly has shown a particular autosomal dominant inheritance.
The 4 is true.
And here comes the problem: 5 also is false as a three euro ticket. The presence of delusions in no way excludes the diagnosis of bipolar disorder. In my opinion, the question is to challenge and, if you do, any manual or tried to psychiatry will give you quotes from wrong in both. If we play to psychoanalysts ( a dangerous game, it must be said), could be interpreted as the author of this question incorrectly translated from English by delirium delirium , and what he meant was that the diagnosis of delirium (delirium) excludes the concomitant diagnosis of bipolar disorder. Of course, if complicated with is to prepare the MIR, one has to walk over interpreting translation errors clueless examiners, forget it ....
143. Indicate which of the following statements is correct in relation to suicide in schizophrenia.
1. The percentage of people with schizophrenia who died by suicide has reached 5%.
2. The presence of cognitive impairment is associated with a lower risk of suicide.
3. The risk of suicide is higher in middle-aged people with several years of evolution of the disease.
4. The risk of suicide is higher in women.
5. The risk of suicide is higher for people from low socioeconomic status.
Let's see: according to the Synopsis of Psychiatry of Kaplan, Ninth Edition (a book often quoted, but very very interesting), in relation to option 1 , the suicide rate paracer reach 10%. It would therefore be false.
From 2 not know what to say. On the one hand, says that patients with further deterioration are less aware of the inability sometimes associated with the disease and kill less. It may be correct.
The 3 is false. The risk is greater in young people with few years of evolution.
The 4 is false. The risk is greater in males.
The 5 I think, but I'm not sure that is not correct, because the risk of suicide is associated, for example, unemployment and social isolation, but often these are consequences rather than causes of schizophrenic disorder. I'm not aware of any such association with suicide (although they do schizophrenia diagnosed more lower social classes, perhaps because of the subjectivity of the professional or perhaps psychosocial factors that cause or cause psychosis is triggered more often than if not present). I guess, but I have them all with me, that we should err on the 2 .
144. A patient 36, a native of another culture living in Spain for 4 years is presented in a SN of Health consultation. Refer present 10 months symptoms of anxiety and depressive mood. This table moderately interferes in their daily activities. Has no previous psychiatric history. This situation occurs following the death in a car accident with an older brother who was very close. Indicate which of the following diagnoses is appropriate:
1. Major depression.
2. Bipolar II disorder.
3. Adjustment disorder.
4. Dysthymia.
5. Cyclothymia.
The relative mildness of the symptoms, not severely interfere in their daily work, in principle excludes the diagnosis of major depression. There are no data showing a hypomanic phases bipolar II disorder. The dysthymia requires a duration of at least two years. The cyclothymia is diagnosed very rare today (because, as Castilla del Pino said in an interview, what were those we now call bipolar cyclothymic, contributing to one of the many psychiatric epidemics of our time), consisting of pole oscillations between depressive and manic, mild. But no data of such oscillations.
The correct answer is, in all likelihood, the 3 . The adjustment disorder appears within 3 months after the stressor and lasts no more than 6 months if it has stopped or its consequences (which is not the case because the patient's imaginary brother is dead.) The mild anxious-depressive symptoms fit this diagnosis. Another example of how to conceptualize and disease that are made (although painful) life. Sure, the imaginary patient takes some antidepressant because maybe some help .
145. After diagnosing a disorder attention deficit hyperactivity disorder (ADHD) as DSM-IV and before treatment with psychostimulants the American Academy of Child and Adolescent Psychiatry proposes putting :
1. ECG, EEG, CT scan, blood count and biochemistry.
2. Physical examination, blood pressure, pulse, weight and height.
3. Physical examination, blood pressure, pulse and EKG.
4. Physical examination, pulse, blood count blood count and biochemistry.
5. Height, weight, EKG and EEG.
The question seems to me quite absurd, of those that are put to aggravate the opponent without it being clear that discriminate at all (if anything, favors the kamikaze with luck, not only respond when hesitating between 5 but they also go and hit ...). Volviend or Kaplan, we have the answer: physical examination, blood pressure, pulse, weight and height. Ie 2.
Well, we hope have been useful. Since many readers of this post are you (almost) first-year residents and a few of these are going to start working in the health system for the first time, we would like to remember (to act as moral hazard) that will labor by the patient and to society with the money of all. When pharmaceutical industry is near you (he will) with (very peculiar) information and (very generous) opportunities to work at your (de) formation, try to maintain your independence at all costs. And if you can not, as we happened to us before, say no thanks and other thing.
luck and congratulations to the winners.
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