SMLE Psychiatry 3 — Questions and Answers
Question 1: A 28-year-old woman presents with recurrent episodes of binge eating followed by self-induced vomiting. She is of normal weight. Physical examination reveals dental enamel erosion and parotid gland enlargement. What is the diagnosis?
- Anorexia nervosa, binge-purge type
- Bulimia nervosa (Correct answer)
- Binge eating disorder
- Rumination disorder
Correct answer: Bulimia nervosa
Bulimia nervosa is characterised by recurrent binge eating followed by compensatory behaviours (purging, laxative use, excessive exercise) at least once a week for 3 months. Unlike anorexia, patients are typically normal weight. Dental erosion and parotid enlargement result from repeated vomiting.
Question 2: A patient being treated with clozapine develops fever, sore throat, and a WBC count of 1,500/μL with an absolute neutrophil count of 400/μL. What is the immediate action?
- Continue clozapine and add antibiotics
- Discontinue clozapine immediately and isolate the patient (Correct answer)
- Reduce the clozapine dose by half
- Add granulocyte colony-stimulating factor and continue clozapine
Correct answer: Discontinue clozapine immediately and isolate the patient
Clozapine can cause agranulocytosis (ANC <500/μL), a potentially fatal adverse effect. Clozapine must be immediately discontinued, the patient isolated due to infection risk, blood cultures obtained, and broad-spectrum antibiotics started. G-CSF may be given as adjunct.
Question 3: A 10-year-old boy has difficulty sustaining attention, is easily distracted, fidgets constantly, talks excessively, and has difficulty waiting his turn. Symptoms have been present since age 5 and affect school and home. What is the most likely diagnosis?
- Conduct disorder
- Attention deficit hyperactivity disorder (ADHD), combined type (Correct answer)
- Oppositional defiant disorder
- Autism spectrum disorder
Correct answer: Attention deficit hyperactivity disorder (ADHD), combined type
ADHD combined type is diagnosed when criteria for both inattention and hyperactivity-impulsivity are met for ≥6 months, with onset before age 12, and symptoms present in ≥2 settings (school and home). This child meets all criteria.
Question 4: A 40-year-old man presents with persistent preoccupation that he has cancer despite multiple normal investigations and reassurance from specialists. The preoccupation has lasted 8 months and causes significant distress. What is the most likely diagnosis?
- Somatic symptom disorder
- Illness anxiety disorder (hypochondriasis) (Correct answer)
- Conversion disorder
- Factitious disorder
Correct answer: Illness anxiety disorder (hypochondriasis)
Illness anxiety disorder (formerly hypochondriasis) involves preoccupation with having or acquiring a serious illness with minimal or no somatic symptoms. Despite normal investigations and medical reassurance, the anxiety persists for ≥6 months.
Question 5: In Saudi Arabia, according to the Mental Health Act and SCFHS guidelines, involuntary psychiatric admission is permitted under which condition?
- When the patient refuses any medication
- When there is imminent danger to self or others due to mental illness (Correct answer)
- When the family requests admission
- When the patient is homeless
Correct answer: When there is imminent danger to self or others due to mental illness
According to Saudi Mental Health Law and SCFHS guidelines, involuntary admission is permitted when a patient with a mental disorder poses an imminent danger to themselves or others, lacks capacity to consent, and requires immediate treatment. Legal safeguards and periodic review are mandatory.
Question 6: A 20-year-old soldier presents after witnessing an explosion with inability to move his legs. Neurological examination and MRI are completely normal. He appears indifferent to his symptoms (la belle indifférence). What is the most likely diagnosis?
- Malingering
- Conversion disorder (functional neurological symptom disorder) (Correct answer)
- Somatic symptom disorder
- Factitious disorder
Correct answer: Conversion disorder (functional neurological symptom disorder)
Conversion disorder presents with neurological symptoms (paralysis, blindness, seizures) that are incompatible with recognised neurological disease. It typically follows a stressor, and la belle indifférence (apparent lack of concern) may be present, though it is not diagnostic.
SMLE Psychiatry 3
A 28-year-old woman presents with recurrent episodes of binge eating followed by self-induced vomiting.
She is of normal weight.
Physical examination reveals dental enamel erosion and parotid gland enlargement.
What is the diagnosis?