A 72 year old man has 4 days of painless haematuria and takes warfarin. Which is the most appropriate initial investigation?

Correct Answer: A

Rationale: In a psychiatric emergency exam scenario where a 72-year-old man presents with painless hematuria and is on warfarin, the most appropriate initial investigation would be A) CT scan of kidneys, ureter, and bladder. This choice is correct because it allows for a detailed visualization of the urinary tract, helping identify potential causes of hematuria such as renal tumors or stones, which are crucial to address promptly in the context of a psychiatric emergency. Option B) Prostate specific antigen level is incorrect as it is primarily used in evaluating prostate conditions like cancer, which may not be the primary concern in this case. Option C) Ultrasound of abdomen may not provide the necessary detailed information about the urinary tract compared to a CT scan. Option D) Urodynamic studies are more invasive and are typically not the initial investigation for hematuria. Educationally, understanding the rationale behind selecting the appropriate initial investigation in a psychiatric emergency setting is vital for healthcare providers to make timely and accurate decisions to ensure patient safety and well-being. By choosing the CT scan, providers can efficiently identify potential causes of hematuria, guiding further management and treatment plans effectively.

Correct Answer: B

Rationale: The correct answer to this question is B) Flight of ideas. Flight of ideas is a symptom commonly seen in manic episodes of bipolar disorder where thoughts rapidly move from one subject to another, often with loose connections between them. In the given statement, the patient's thoughts are disjointed, jumping from "Home is sweet" to "diabetes urine has sweet" to "sweet is hell," indicating a rapid and disorganized flow of ideas. Option A) Derailment refers to a sudden shift in thought topics that are completely unrelated, which is not as evident in the patient's statement. Option C) Neologism involves creating new words or phrases that are meaningless to others, which is not present here. Option D) Loosening of association refers to a more severe form of thought disorder where there is an absence of logical connections between thoughts. Educationally, understanding symptoms of psychiatric emergencies like flight of ideas is crucial for healthcare providers, especially in emergency situations where quick and accurate assessment is needed to provide appropriate care. Recognizing these symptoms can help in making a timely diagnosis and initiating proper interventions to ensure the safety and well-being of the patient.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Labile affect. Labile affect refers to rapid and unpredictable changes in emotions, such as laughing one minute and crying the next without an apparent cause. This symptom is commonly seen in psychiatric emergencies and can indicate underlying mood instability or neurological conditions. Option A) Incongruent affect does not fully capture the rapid and fluctuating nature of the emotional changes described in the case. Incongruent affect typically refers to emotions that are not in line with the situation or context. Option B) Elation specifically denotes a state of intense happiness or joy, which does not encompass the wide range of emotions exhibited by the individual in the case. Option D) Flat affect is characterized by a lack of emotional expression and would not align with the alternating laughter and crying displayed by the 20-year-old male. Educationally, understanding psychiatric emergencies and associated symptoms like labile affect is crucial for healthcare professionals, especially in settings like emergency departments or mental health facilities. Recognizing and correctly identifying these symptoms can guide appropriate interventions and ensure the individual receives timely and effective care. By differentiating between terms like labile affect, incongruent affect, elation, and flat affect, healthcare providers can make informed clinical decisions to support patients in crisis.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Somatic passivity. Somatic passivity is a symptom commonly seen in psychiatric emergencies where individuals feel their bodily sensations are controlled by external forces, such as chemicals sprayed by colleagues in this case. This symptom is often associated with schizophrenia and other psychotic disorders. Option A) Automatic obedience refers to a phenomenon where a person follows commands without question, which is not described in the scenario. Option B) Visual hallucination involves seeing things that are not present, which is not mentioned in the patient's report of a tickling sensation. Option C) Delusion of persecution involves a false belief that one is being targeted or harmed, which is not directly related to the physical sensation described by the patient. Understanding psychiatric emergencies is essential for healthcare professionals to provide timely and appropriate care to individuals experiencing mental health crises. Recognizing symptoms like somatic passivity can aid in accurate assessment and intervention, leading to better outcomes for patients in distress. It is crucial to differentiate between various symptoms to provide targeted and effective support in psychiatric emergency situations.

Correct Answer: C

Rationale: The correct answer is C) Depression is a common comorbidity in obsessive-compulsive disorder (OCD). This is a true statement because individuals with OCD often experience co-occurring depression, with estimates suggesting that around 50% of individuals with OCD also have major depressive disorder. Option A is incorrect because atypical antipsychotics are not the first line of treatment for OCD. Instead, the first-line treatments for OCD typically include selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT). Option B is incorrect as the prevalence of OCD in the general population is estimated to be around 1-2%, not 7-10%. Option D is also incorrect as contamination is actually a very common obsession in individuals with OCD, alongside other common obsessions like fears of harming others or symmetry. Educationally, understanding the common comorbidities of OCD, such as depression, is crucial for healthcare providers to accurately diagnose and treat individuals with this disorder. Recognizing these patterns can help in developing comprehensive treatment plans that address both OCD symptoms and any co-occurring conditions like depression, leading to better outcomes for patients.