SMLE Psychiatry 4

Question 1

A 32-year-old woman has a pervasive pattern of instability in interpersonal relationships, marked impulsivity, recurrent self-harm, chronic feelings of emptiness, and frantic efforts to avoid abandonment. What personality disorder is most likely?

Accepted Answer

Borderline personality disorder

Answer

Borderline personality disorder (BPD) is characterised by instability in relationships, self-image, and affects, marked impulsivity, self-harm, chronic emptiness, and desperate avoidance of abandonment. Dialectical behaviour therapy (DBT) is the evidence-based treatment.

Question 2

A patient on an SSRI starts taking tramadol and develops agitation, myoclonus, hyperreflexia, diaphoresis, and diarrhoea. What is the most likely diagnosis?

Accepted Answer

Serotonin syndrome

Answer

Serotonin syndrome results from excessive serotonergic activity, often from combining serotonergic drugs (SSRI + tramadol). The triad includes altered mental status, autonomic instability, and neuromuscular hyperactivity (myoclonus, hyperreflexia). Treatment involves stopping offending agents and cyproheptadine.

Question 3

A mother brings her 3-year-old child who does not speak, avoids eye contact, engages in repetitive hand flapping, and lines up toys in a specific order. What is the most likely diagnosis?

Accepted Answer

Autism spectrum disorder

Answer

Autism spectrum disorder (ASD) is characterised by persistent deficits in social communication and interaction (poor eye contact, lack of speech) and restricted, repetitive patterns of behaviour (hand flapping, lining up objects). Diagnosis is typically made by age 2-3.

Question 4

A 55-year-old man with chronic alcoholism is found confused with confabulation, anterograde amnesia, and ataxia. Thiamine was not administered during his recent hospital admission. What is the diagnosis?

Accepted Answer

Korsakoff syndrome

Answer

Korsakoff syndrome is characterised by severe anterograde amnesia and confabulation (fabrication of memories to fill gaps) following Wernicke encephalopathy due to thiamine (B1) deficiency. It represents the chronic, irreversible phase of Wernicke-Korsakoff syndrome.

Question 5

What is the first-line medication for obsessive-compulsive disorder (OCD)?

Accepted Answer

SSRIs at high doses

Answer

SSRIs at higher doses than used for depression (e.g., fluoxetine 40-80 mg, fluvoxamine 200-300 mg) are first-line pharmacotherapy for OCD. Clomipramine (a tricyclic with strong serotonergic activity) is an alternative. CBT with exposure and response prevention is the first-line psychological treatment.

SMLE Practice Test

SMLE Practice Test

SMLE Psychiatry 4