OSCE Mental Health Assessment 5 — Questions and Answers
Question 1: In an OSCE focused on personality disorders, a patient repeatedly idealizes then devalues treatment team members, has chronic feelings of emptiness, and a history of self-harm. The most likely diagnosis is:
- Narcissistic personality disorder
- Histrionic personality disorder
- Borderline personality disorder (Correct answer)
- Antisocial personality disorder
Correct answer: Borderline personality disorder
Splitting (idealization/devaluation), identity disturbance, self-harm, and chronic emptiness are hallmark features of borderline personality disorder.
Question 2: A patient presents with fear of eating in public, avoidance of social gatherings, and physiological symptoms (sweating, trembling) triggered by perceived scrutiny. The GAD-7 is 6 and the PHQ-9 is 5. The most appropriate primary diagnosis is:
- Generalized anxiety disorder
- Social anxiety disorder (social phobia) (Correct answer)
- Major depressive disorder
- Panic disorder
Correct answer: Social anxiety disorder (social phobia)
Fear of negative evaluation in social/performance situations leading to avoidance is the defining feature of social anxiety disorder.
Question 3: During an OSCE psychiatric interview, the student asks, 'Do you ever feel that events on TV or radio have special meaning just for you?' This question screens for:
- Thought broadcasting
- Ideas of reference (Correct answer)
- Persecutory delusions
- Grandiose delusions
Correct answer: Ideas of reference
Ideas of reference are beliefs that neutral external events (TV, radio, strangers' behavior) carry a special personal message directed at the patient.
Question 4: In an OSCE focused on motivational interviewing for a patient with alcohol use disorder, which statement best exemplifies a 'change talk' response by the clinician?
- 'You really need to stop drinking before your liver fails.'
- 'What are some reasons you might want to cut back on drinking?' (Correct answer)
- 'Most of my patients in your situation choose abstinence.'
- 'I'm going to refer you directly to inpatient detox today.'
Correct answer: 'What are some reasons you might want to cut back on drinking?'
Evoking the patient's own reasons for change through open questions is the core technique of motivational interviewing.
Question 5: A patient taking lithium presents with coarse tremor, confusion, ataxia, and nausea. The serum lithium level is 2.4 mEq/L. The priority intervention is:
- Reduce lithium dose by 50% and recheck level in 1 week
- Add propranolol for tremor management
- Discontinue lithium and initiate supportive care, consider hemodialysis (Correct answer)
- Switch to valproate and continue current lithium at a lower dose
Correct answer: Discontinue lithium and initiate supportive care, consider hemodialysis
A lithium level >2.0 mEq/L with neurological toxicity (confusion, ataxia) constitutes severe toxicity requiring immediate discontinuation and possible hemodialysis.
Question 6: An OSCE examiner asks a student to assess 'affect' in a patient. Which observation correctly demonstrates a blunted affect?
- The patient rapidly cycles between laughing and crying without apparent stimulus
- The patient's emotional expression is minimal and restricted in range despite distressing content (Correct answer)
- The patient's reported mood does not match their observed emotional expression
- The patient expresses intense emotions disproportionate to the context
Correct answer: The patient's emotional expression is minimal and restricted in range despite distressing content
Blunted affect is characterized by significantly reduced emotional expression in range and intensity, regardless of the content being discussed.
Question 7: A 45-year-old woman reports episodes of intense fear with palpitations, chest tightness, shortness of breath, and derealization peaking within 10 minutes and resolving spontaneously. Between episodes she fears another attack and avoids public transport. The best initial pharmacological treatment in the US is:
- Diazepam 5mg three times daily
- Sertraline titrated to 50–200mg daily (Correct answer)
- Haloperidol 2mg daily
- Buspirone 10mg twice daily
Correct answer: Sertraline titrated to 50–200mg daily
SSRIs such as sertraline are first-line pharmacotherapy for panic disorder per APA guidelines, with benzodiazepines reserved for short-term adjunctive use.
OSCE Mental Health Assessment 5
In an OSCE focused on personality disorders, a patient repeatedly idealizes then devalues treatment team members, has chronic feelings of emptiness, and a history of self-harm.
The most likely diagnosis is: