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Solved EMIs Autumn 2007

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Please feel free to differ and criticize. These answersaren't final yet.

EMIs Autumn 2007

EMI 1

Theme: Sleep disorders

Options:

A. Circadian rhythm sleep disorder

B. Shift work sleep disorder

C. Narcolepsy

D. Obstructive sleep apnoea

E. Limb movement disorder

F. Somnambulism

G. Delayed sleep phase syndrome

Select one option in all questions below:

1. A 25 year old female falls asleep in the daytime and loses her balance with cataplexy

C. Narcolepsy

2. A 40 year old obese man complains of cough during the night.

D. Obstructive Sleep apnoea

3. A 30 year old man has been depressed and is prescribed by his GP flupenthixol tablets. He later comes back to the GP complaining of sleep disturbance and fatigue in the daytime.

G. Delayed sleep phase syndrome

EMI 2

Theme: Drug use

Options:

A. Alcohol

B. Amphetamines

C. Cocaïne

D. Volatile substances

F. Benzodiazepines

G. Magic mushrooms

H. Caffeine

I. Cannabis

J. Phencyclidine

1. A 17 year old man with a 2 year history of drug abuse went on an all night party and presented to A & E with dilated pupils, tachycardia, tremors and sweating – (Select 2 options)

B. Amphetamines

H. Caffeine

http://www.emedicine.com/emerg/topic23.htm (Diaphoresis)

2. A 19 year old factory worker with a history of various illicit drugs presented to A & E. He said he had a bad trip and on examination he has dilated pupils, tremors and sweating – (Select 2 options)

G. Magic mushrooms

J. Phencyclidine

Ref. Puri and Hall p. 362

A 20 year old man presented to A & E with tachycardia, sweating, tremors and increase in muscle tone, history of 2 seizures. He has a history of substance use – (Select 2 options)

A. Alcohol

F. Benzodiazepines

EMI 3

Theme: Side effects of medications - receptors

Options:

Alpha-1 receptor antagonism

Down regulation of alpha-2 adrenergic receptors

Action at the 5-HT1A receptor

H1 receptor antagonism

CYP450 enzyme induction

CYP450 enzyme inhibition

D2 receptor antagonism

Select one option

1. Patient who has been on risperidone complained of postural instability.

Alpha-1 receptor antagonism

2. A patient who is on carbamazepine says that the oral contraceptives she has been taking have not been working.

CYP450 enzyme induction

3. Patient on fluoxetine has not been doing well and lithium has been started as an augmentation and he started having tremors, instability of gait, sweating and confusion.

Action at the 5-HT1A receptor

Ref. http://www.drugs.com/drug_interactions.php

EMI 4

Theme: Appropriate treatment in child and adolescents

Options:

Parental training

Fluoxetine

Citalopram

Methylphenidate

Lithium

Family training

Risperidone

Select one option

1. A 13 year old boy who has been treated under a psychologist for his aggression is receiving CBT treatment and his psychologist has diagnosed him of having hyperkinetic disorder.

Methylphenidate

2. A 17 year old boy who has been abandoned by his family because of his aggression. What is the most appropriate treatment?

Family training

3. A 14 year old boy has been more aggressive after a conflict between his parents and his mother brought him to hospital complaining that he wouldn’t listen to anything.

Parental training

EMI 5

Theme: Psychotherapy

Options:

Reassurance

Show empathy

Clarification

Ask to reflect

Link the present state to the childhood relationships

Name the emotion

Listen and think quietly

A 17 year old male comes to the first session of your therapy and he keeps coming late to the therapy. Recently he broke up with his girlfriend and at one situation he tries to be angry with you and says that he would like to kill himself. – 3 options

Show empathy ,

Ask to reflect ,

Reassurance .

The same person keeps coming regularly to the sessions. After a few sessions he becomes angry again and starts coming late to the sessions, even though attending them and when you tell him that the sessions are going to end he says that you are going to abandon him and that he will die. – 2 options

Link the present state to the childhood relationships

Show empathy

The same person keeps coming to the sessions, makes good progress but once reports to you of a dream in which he was on a train which goes very fast and ends up in a plane crash. He asks you what does that mean. – 1 option

Ask to reflect

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EMI 6

Theme: Side effects of medications

Options:

Ebsteins anomaly

Fallot’s tetrology

Irritability in newborn

Neural tube defects

Select 1 option

1. Question of pregnant woman taking lithium and possible side effect to the baby.

Ebsteins anomaly

2. Question of pregnant woman on paroxetine and possible side effect to the baby.

Irritability in newborn

3. Question of pregnant woman on sodium valproate and possible side effect to the baby

Neural tube defects

Please feel free to differ and criticize.

Thanks

Kamran

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