Consultation-Liaison Psychiatry (Psychiatric Aspects of Medical Illness) MCQs

Psychiatry · 14 free questions with answers & explanations.

1. A 55-year-old post-CABG patient develops acute-onset fluctuating confusion, disorganised speech, and visual hallucinations on day 2. He is agitated at night but somnolent during the day. His oxygen saturation is 94% on room air and Na is 131 mEq/L. The most likely diagnosis is:
2. A 60-year-old woman with newly diagnosed pancreatic cancer requests psychiatric consultation for persistent low mood, anhedonia, and 'a feeling of complete hopelessness about the future.' She scores 18 on PHQ-9. Which feature in this oncology consultation setting is most important to distinguish Major Depressive Disorder from understandable grief/sadness?
3. A 45-year-old with SLE on high-dose prednisolone develops euphoria, pressured speech, grandiose delusions, and decreased need for sleep 3 weeks into treatment. Which is the most likely diagnosis?
4. A patient with end-stage renal disease on haemodialysis is found to have significant depressive symptoms. The MOST appropriate antidepressant choice, considering renal clearance and safety?
5. A 68-year-old man with advanced pancreatic cancer develops severe depression. Which antidepressant is preferred in this setting due to its fast onset, low drug interaction profile, and tolerability in medically ill patients?
6. A 55-year-old post-cardiac surgery patient in the ICU develops acute onset confusion, agitation at night, and lucid periods during the day. EEG shows diffuse slowing. What is the MOST likely psychiatric diagnosis and the preferred pharmacological treatment?
7. A 44-year-old woman on dialysis thrice weekly reports profound fatigue, anhedonia, insomnia, and poor appetite. Her nephrologist suspects major depressive disorder. Which rating scale is validated for assessing depression specifically in renal failure patients?
8. A 30-year-old man presents with multiple ER visits for diverse non-specific symptoms (chest pain, abdominal pain, headache), extensive investigations yielding no pathology, and he visits three different physicians simultaneously. He denies any connection between symptoms and his recent job loss. The DSM-5 diagnosis is:
9. A 65-year-old man recovering from CABG surgery develops sudden disorientation, visual hallucinations, and agitation on the 3rd post-operative night. He has a normal WBC and afebrile. Which is the MOST likely diagnosis and its predisposing factor?
10. A 45-year-old woman with end-stage renal disease on haemodialysis reports persistent low mood, fatigue, poor concentration, and loss of interest for the past 6 weeks. She attributes all symptoms to her kidney disease. In this consultation-liaison context, which symptom is MOST specific for a comorbid depressive disorder (rather than uraemic/medical symptoms)?
11. A 72-year-old man on day 3 post-total hip replacement develops fluctuating confusion, disorientation at night (worse), visual hallucinations, and agitation. His family says he was cognitively intact before surgery. Which investigation is MOST important to order first?
12. A 55-year-old woman with chronic renal failure on haemodialysis develops persistent depressive symptoms. Which antidepressant should be used with GREATEST caution in this patient due to active metabolite accumulation?
13. A patient with systemic lupus erythematosus (SLE) develops psychosis, mood lability, and cognitive decline. The psychiatrist must first differentiate primary neuropsychiatric lupus (NPSLE) from steroid-induced psychosis. Which feature FAVOURS steroid-induced psychosis?
14. In delirium management in the ICU, which non-pharmacological intervention has the STRONGEST evidence for prevention?