Невроз навязчивых состояний. Психотерапия, транквилизаторы, антидепрессанты

For 6th year interns

05 В 130100 "General Medicine" direction "General Practitioner

Number of credits - 4

Number of tests: 1X20 = 80 tests

#1

*! Patient N., 54 years old. Seems tired and depressed. When talking, she is somewhat animated, actively and emotionally complains of headaches, head noise, dizziness, fatigue and decreased capacity for work, poor tolerance of noise and stuffiness, irascibility, tearfulness, forgetfulness, bad mood. Depending on the topic of conversation, the mood easily fluctuates from crying to smiling. Confuses dates when giving anamnestic information. Asks for help to be able to work until retirement.

Which of the following is the most likely disorder?

Астенический синдром, предположительно сосудистого происхождения (склероз сосудов головного мозга).

* Ажитирленген үрей

*+Астениялық синдром, қан тамыр тегі.

* Апатиялық депрессия

* Кандинский-Клерамбо психикалық автоматизмдер синдромы

* Маскирленген депрессия

#2

*! Patient V., 40 years old, a music teacher. By her nature, she is impressionable, mistrustful and capricious. Loves to be the center of attention of others. Considered to be a "hottie," but irritable, incivable and jealous in the family. Her condition began soon after the second birth, which was difficult and had many complications. Taking care of the child took a lot of strength. After a quarrel with her husband's relatives, she was upset, cried, spoke with affectation about her unwillingness to live. At the same time the thought arose in her mind that she was ill with cancer. She vividly and figuratively imagined a tumor in her belly, which was spreading to her internal organs. It was disintegrating, forming ulcers. She herself was frightened by these thoughts and tried to drive them away, but they continued to haunt her, causing her anxiety and fear. She turned to a general practitioner, who found any diseases of internal organs. For some time the patient calmed down, but soon the thought of possible death in severe agony arose again. At the reception, obsessive thoughts of a serious illness, of death. She understood the groundlessness of her fears, but could not get rid of them. Fears "going crazy" and staying in a psychiatric hospital for the rest of his life.

What is the most likely preliminary syndromal diagnosis?

Ipochondric syndrome

Какой предварительный синдромальный диагноз НАИБОЛЕЕ вероятен? Навязчивые ипохондрические идеи.

* Параноидты синдром

* Паранояльді синдром

* Котар синдромы

* + Ипохондриялық синдром

* Депрессивті синдром

 

 

#3

*!Patient V., age 40. During the interview she says: "I am constantly in a state of fear for my life. On the one hand, I am well aware that nothing will happen to me, and at the same time, I am afraid that any of my actions may adversely affect my health. When I walk down the street, I involuntarily start counting some things, objects, be they poles, houses, cars. When it seems to me that I have counted correctly, I calm down for a while. If for some reason I stray from counting, there is a fear that trouble awaits me. It is especially difficult at work. Having completed some task, I start to doubt whether everything was done correctly. If I find that some detail was not done properly, I immediately feel weak, palpitating, and trembling. I feel that I can't change or redo anything, and I can only wait to see how it all ends. I am constantly in a double state: I know I must work and provide for my family, but I cannot get down to work because of an intolerable feeling of fear for my health. What treatment is indicated for this patient?

Паранойяльный синдром, параноидное расстройство личности

Нейролептики/антипсихотики

*рекуррентті депрессивті бұзылысы, нейролептиктер, нормотимиктер

* индуцияланған сандырақ бұзылысы, нейролептиктер, психотерапия

*+тұлғаның параноидты бұзылысы, психотерапия, нейролептиктер

*диссоциацивтік бұзылысы, антидепрессанттар, ноотроптар

*параноидты шизофрения,нейролептиктер, антидепрессанттар

 

 

#16

*! A 50-year-old man, who was in a psychologically traumatic situation against the background of low mood, has motor agitation, the patient is frantic, anxiety and melancholy. Expresses ideas of self-blame and self-deprecation. Asks for "poison", as she thinks her exit from life will relieve her and those around her. Periodically moans, sobs, "cannot find her place. Determine type of agitation, determine appropriate treatment?АЖИТИРОВАННАЯ ДПРЕССИЯ

ИСТЕРИЧЕСКИЙ ПСИХОЗ

*шизофрения

*эпилепсия

*+реактивті психоз

*ипохондриялық невроз

*психикалық аурудың белгісі жоқ.

#39

*! A 35-year-old woman has suffered from a number of psychotraumatic events over the last two years (burglary of her apartment, heart attack on her husband, conflicts at work). After that her mood gradually changed, her sleep became disturbed, she became tearful, constantly worried about the future, sometimes cannot find herself at home, calls her adult children several times a day just to find out if they are alright, has lost 10 kg in weight. During the visit she expresses thoughts about her inferiority, considers herself a bad wife and mother, since she has stopped coping with household chores. Actively seeks help, is critical of painful manifestations.

Which of the following syndromes and psychiatric disorders is most likely?

ПСИХОГЕННАЯ ДЕПРЕССИЯ,

*+Аралас үрейлі-депрессивті бұзылыс, үрейлік-депрессивтік синдром

* Оганикалық үрейлі-депрессивті бұзылыс, обсессивті-фобиялық синдром

* Оганикалық үрейлі бұзылыс, астено-невротикалық синдром

*Неврастения, астено-невротикалық синдром

* МДП, депрессивті синдром

 

#40

*! Female, 32 years old, complains of fear of contracting viral hepatitis. For 2 years she has been obsessed with constantly controlling the cleanliness of both the room and her hands. Frequently washes her hands, wipes them with alcohol, does not open doors without gloves. Has become indecisive, sluggish, and spends a lot of time on the ritual of cleaning her hands. Understands the futility of the rituals performed, considers them a symbolic attempt to prevent danger. What treatment is indicated for this patient?

РАЦИОНАЛЬНАЯ ПСИХОТЕРАПИЯ

*гипнотерапия, антидепрессанттар.

* нейролептиктер, транквилизаторлар, 

*+рациональды психотерапия, нейролептиктер, антидепрессанттар

*рациональді психотерапия, треанквилизаторлар, антидепрессанттар

*суггестивті психотерапия, нейролептиктер, транквилизаторлар

 

 

#41

*! A mother and her 3.5-year-old child went to a general practitioner. According to the mother, the child has poor appetite, sits badly, walks badly, does not ask to go to the potty, has practically no play activity, lags behind his peers in physical development. Which disorder is most characterized by these symptoms?

РАССТРОЙСТВО ПСИХОЛОГИЧЕСКОГО РАЗВИТИЯ

* Балалар шизофрениясында

* Жас нормаларына сәйкес дамыту

* + Психикалық дамудың бұзылуында

* Педагогикалық тежелу кезінде

* Депрессия

 

 

#42

*! A mother came to see her 9-year-old child. According to his mother, the boy constantly complains of abdominal pain, headache, nausea; he often refuses to go to school, has recently appeared to have nocturnal urinary incontinence, has started sucking his thumb. According to the data of objective examination and consultations of narrow specialists, no pathology was detected. What mental disorder is most likely to occur in the child?

ЭМОЦИОНАЛЬНОЕ НАРУШЕНИЕ

* естің

* + эмоциялар

* интеллектттің

* мінез-құлық

* қозғалыс-еріктің

 

 

#43

*! At an appointment with a general practitioner, a mother with a 4-year-old child. According to the mother's words, the child does not sit still, has constant tantrums. The kindergarten teachers complain that the child is excessively chatty and mobile, is inattentive in play-based activities, constantly bumps into something, tries to get into something, constantly fights with children. Which mental health disorder is most likely to occur in a child?

РАССТРОЙТСВО ПОВЕДЕНИЯ

* + мінез-құлық

* ойлау

* эмоциялар

* ерік

* сана

 

#44

*! A mother brought her 4.5-year-old child to see a general practitioner, concerned about his behavior. According to his mother, the child refuses to do what he is told, whines, quarrels with children in kindergarten, "hysterics" 2-3 times a week, but quickly recovers. Upon objective examination, his mental and physical development is within the age norm. What condition is the most typical for this child?

ВЫЗЫВАЮЩЕЕ ПОВЕДЕНИЕ

* психикалық дамудың тежелуі

* +өзіне қарататын мінез-құлық

* ақыл-ой кемістігі

* назар тапшылығы синдромы

* психопатия

 

#45

*! At an appointment with a general practitioner, a mother and her child, 10 years old. According to the mother, the child does not cope with the school program, has difficulties in communicating with his classmates, and cannot do his homework. What is your medical tactic as a GP, primarily in accordance with the mh-GAP program? ОЦЕНКА ВСЕХ ПСИХИЧЕСКИХ ФУНКЦИЙ

* психиатрға консультацияға жіберу қажет

* мектептен мінездеме сұрастыру қажет

* психотерапевтке кеңес беру

* +барлық проблемалы психикалық функцияларды бағалау қажет

* невропатолог кеңесіне жіберу

 

#46

*! A woman came in for a follow-up visit with an 8-year-old child who you identified as emotionally disturbed. What are your recommendations for further education of the child?

ОТСАВИТЬ В ПРЕЖДНЕЙ ШКОЛЕ

* үйде оқытуға көшіру

* сыныптардағы балалар саны 5 адамнан аспайтын жабық жеке мектепке ауыстыру

* баланы қосымша бағдарлама бойынша мектепке ауыстыру

* арнайы оқу орнын табу

* +бұрынғы мектепте қалдыру, бірақ буллинг жағдайын болдырмау

 

#47

*! You, a general practitioner, have parents with a 9 year old child whom you have been seeing for the last 6 months with a diagnosis: Attention deficit syndrome, in dynamics and at the time of the examination you do not see any improvement in his mental state. What is your medical course of action? ОТПРАВИТЬ НА КОНСУЛТЬАЦИЮ К ПСИХИАТРУ

* +мүмкіндігінше психиатрға консультацияға жіберіңіз

* өздігінен психотроптық препараттарды тағайындаңыз

* невропатолог кеңесіне жіберіңіз

* нейропротективті ем тағайындаңыз

* жалпы бекітетін терапияны тағайындау

 

#48

*! A grandmother came to see you with her 5-year-old grandson. According to the grandmother, the child does not communicate with anyone, speaks poorly, walks badly, does not ask to go to the potty, eats poorly on his own, there is almost no play activity, does not respond to the name. We also tried to take him to a preschool, but the child could not adapt there, and the educators suggested he go to a medical facility. What are your medical tactics as a GP in accordance with the recommendations of the mh-GAP program?

ПРОВЕРКА НА ТУГОУХОСТЬ

* психотроптық препараттарды тағайындау

* +бірінші кезекте есту қабілетінің бұзылуын болдырмау қажет

* витаминотерапия тағайындау

* нейропротективті ем тағайындау

* дефектолог-педагогқа жүгіну ұсынылсын

 

#49

*! A 13-year-old boy, accompanied by his father, came to the doctor's appointment on the recommendation of the school psychologist. The boy's father said that they did not live together, as he had been divorced for the past year, but that he communicated with the child. According to the father, they were advised to see a general practitioner since they refused to see a psychiatrist. During the interview with the school psychologist, the teenager said that he did not want to live and was thinking about killing himself. The father reports that his son has been reluctant to communicate with him lately, although he has always had a warm relationship, blames himself for his parents' divorce, as his behavior and poor academic performance caused his parents to quarrel constantly, and considers himself an unworthy person. The teenager enters into conversation reluctantly, his facial expression is sorrowful and he says he is not worth listening to at all. He speaks in a low voice, in one sentence, saying that "he is not worthy to live, that he is grey, a bad son, a bad friend, that his parents divorced because of him," and also reported that he even tried to commit suicide, but, his mother came home early and he did not have time to do everything, but, his mother did not notice. Assess this teenager's suicide risk.

РИСК ВЫСОКИЙ,ЗНАЧИТЛЕЬНЫЙ

* суицид қаупі жоқ, тек атаөанасының назарын аудару тәсілі

* + елеулі немесе төтенше тәуекел

* орташа тәуекел

* төмен немесе болмашы тәуекел

* суицид тәуекелін бағалаудың қажеті жоқ

 

#50

*! An adolescent boy, 12 years old, at a follow-up visit to a general practitioner accompanied by his mother after a diagnostic examination. At the first visit, upon careful questioning, the boy complained of a bad mood, unwillingness to play even computer games, unwillingness to do anything, unwillingness to go for a walk. His mother was concerned that his school performance had dropped, and there were frequent absences from school because the child would not go to school because he complained of headaches and stomach aches. In connection with the above, the child was thoroughly examined and consulted by narrow specialists, who found no pathology. What is the MOST characteristic illness of this adolescent?

ДЕПРЕССИЯ

* бала мүлдем сау, жай ғана мектепке барғысы келмейді

* + депрессия

* аутизм

* шизофрения

* назар жетіспеушілік синдромы

 

#51

*! There is a girl, 16 years old, accompanied by her mother, who brought her in because in the last 2 months her daughter had lost a lot of weight, refused to eat, did not sleep well, was constipated. The teenager herself says that she is unattractive, fat, ugly, and that this is why her boyfriend left her. She complained about a feeling of hopelessness, melancholy, her own worthlessness and unwillingness to live. From anamnesis you know that two months ago, she broke up with a young man, he initiated the breakup. The patient was examined by different specialists in private practice, underwent instrumental examination and no pathology was detected. And, as it is necessary to be released from the examinations, I applied to the local doctor.

What disease is most likely to occur in a teenager and what is your medical tactic?

ДЕПРЕССИЯ

* + депрессия

* бейімделудің бұзылуы

* аралас алаңдаушылық-депрессиялық бұзылулар

* соматоформды бұзылулар

* ипохондриялық бұзылулар

 

#52

*! Teenager E., 16 years old, a college student. According to her parents, for a month her mood is lowered mainly in the morning hours, appetite is reduced, she lost weight, has lost interest in activities and sports, which she was enthusiastic about, often there is no reaction to surrounding circumstances, but there are characteristic diurnal fluctuations, when suddenly there are short bursts to former hobbies. Became irritable, moody, tearful, expresses various complaints about her health, but examination did not reveal any somatic diseases.

Which group of psychotropic drugs is this patient primarily indicated for?

АНТИДЕПРЕССАНТЫ

* нейролептиктер

* антиконвульсанттар

* литий тұздары

* + антидепрессанттар

* нормотимиктер

 

#53

*! The child is 8 years old and is being seen by a general practitioner, accompanied by his parents. The parents are concerned that the child has not been playing his favorite games for the past month, does not read, does not want to go anywhere, has started saying he is bad, has not been eating and sleeping well. In the interview, the boy confirms the parents' fears. What groups of medications should the child NOT be prescribed in the first place?

АГТИДЕПРЕССАНТЫ НЕ НАЗНАЧАЮТСЯ ДО 12 ЛЕТ

* + 12 жасқа дейін антидепрессанттарды тағайындау ұсынылмайды

* антидепрессанттар

* нейролептиктер

* ұйықтататын препараттар

* нормотимиктер

 

#54

*! A 7-year-old child, brought to the appointment by her grandmother, with whom the child lives, because the child's parents had gone abroad to study. The grandmother noticed that her grandson stopped eating, and if she can get him to eat, he does not eat much and reluctantly, she also noticed that he does not fall asleep for a long time, he does not want to talk to her, his friends stopped coming to him and he stopped going to them, he does nothing at home. I brought him to the appointment because I was worried if my grandson was sick. The boy himself says that he is bad, that he is stupid, why play with him so stupid, that he misses his parents a lot, that he is not worthy to be taken away by his parents. Your doctor's tactic?

НЕ НАЗНАЧАТЬ АНТИДЕПРЕССАНТЫ

* Осы бала туралы алғашқы психикалық денсаулық орталығына хабарлау

* оған антидепрессанттармен емдеуді тағайындау

* осы бала туралы қамқоршылық және қорғаншылық органдарына хабарлау

* +антидепрессанттарды тағайындамау, психоәлеуметтік факторларға назар аудару, тұрақты бақылау жасау

* барлық әлеуметтік қызметтер мен милицияны осы отбасын бақылауға тарту

 

#55

*! In the anamnesis the boy of 7 years old has an advanced development - at 9 months he distinctly pronounced separate words, differentiated faces of people around him, played games - "ladushki", "koo-koo", independently used a spoon, coped with physiological needs when putting him on the potty. He tried to get up and took several steps holding onto the edge of the playpen. After the fall from the couch at the age of 10 months, signs of inverse development - he stopped using speech, could only repeat individual words spoken by adults, simply manipulated the spoon in his hands, did not understand what it was for, he stopped crawling, gradually his emotional coloring levelled off, he did not show the reactions of animation to his mother and father which he had before.

Determine the correct route for the patient:

ПСИХИАТР-ПСИХОЛОГ-НЕВРОЛГ-ЛОГОПЕД

* Балалар неврологының, балалар психиатрының, логопедтің консультациясы

* Логопедтің, балалар неврологының, психологтың кеңесі

* Психолог, логопед және балалар психиатрына кеңес беру

* Психиатр, балалар неврологы, психолог кеңесі.

*+ Балалар психиатрының, психологтың, балалар неврологының, логопедтің консультациясы.

 

#56

*! Young man, 18 years old, euphoric, lethargic, does not immediately understand the speech addressed to him, Speech slurred, one-syllable answers. On examination: sharp constriction of the pupils, sparse breathing, pulse - 45 per minute, smell of alcohol is not felt. Determine the type of intoxication:

*барбитуратармен

*+апиынмен

*гашишпен

*кокаинмен

*амфетаминмен

 

 

#57

*! An 18-year-old male is euphoric, lethargic, sleepy, speech slurred, coordination of movements disturbed, does not immediately understand the speech addressed to him, face slightly hyperemic, pupils not sharply dilated, smell of alcohol is not felt. Determine the type of intoxication:

*+барбитуратармен

*апиынмен

Гашишпен

*кокаинмен

*эфедринмен

 

#58

*! Young man 18 years old, euphoric, somewhat excited, dancing on the spot, laughing, eyes shining. On examination: sclerae injected, face hyperemic, nasolabial triangle pale, licks dry mouth, no smell of alcohol. Diagnosis:

*маниакальды синдром

*апиындық масаю

*+гашиштік масаю

*кокаиндік масаю

*барбитураттармен масаю

 

#59

*! Young man of 16, euphoric, somewhat excited, verbose, impulsive, occasionally aggressive, pale face, wide pupils, blood pressure - 160/90, tachycardia and slight tremor noted, complains of pain in the sternum. Diagnosis:

*маниакальды синдром

*апиындық масаю

* алкогольмен масаю

+кокаиндік масаю

*канабиноидтармен масаю

 

#60

*! A young man of 23 was detained by the police due to severe agitation and incongruous behavior. He was running away from imaginary pursuers, screaming, and attacking a policeman. He regained consciousness on the way to the hospital. In the emergency room, the smell of alcohol on his breath was noted. Correctly oriented to place, time, his own personality. Did not reveal any psycho-productive symptoms during the interview.

The condition can be qualified as:ПОМРАЧЕНИЕ СОЗНАНИЯ

*онейроид

*+сананың қарауытуы

*делирий

*эпилептикалық статус

*аменция

 

 

#61

*! The patient has been abusing alcohol for 5 years. During the period of abstinence, he becomes irritable, his mood lowers, and he experiences a strong craving for alcohol. In order to achieve "satiety" he needs more and more doses of alcohol, he initiates the use of alcohol in company. Often forgets individual events of the previous "drinking party. What is your medical tactic depending on the diagnosis?

НАЛОКСОН

 

#71

*! Teenage girl, 14 years old, raised by one mother since early childhood, no father. In kindergarten bullied by peers, at school she constantly experiences bullying - verbal bullying: "They humiliate me, they laugh, make jokes about how I'm not fashionable, that I do not study well, that my mom is 50 years old, and their moms are young... At school they say that I am "Down", "Loser", "Freak", etc. Because of this I started to be afraid of people, I feel lonely all the time, I never had any friends or girlfriends either. And I think I have a huge problem with my appearance. It seems that I am the ugliest person in the world. For the past two years, a constant feeling of apathy, hopelessness. I can't study at all, I don't understand many subjects. I do not know what to do next. I don't want to live.

What is the most likely preliminary syndrome diagnosis? ПСИХОГЕННАЯ ДЕПРЕССИЯ

* Ипохондриялық синдром

* Эндогенді депрессия

* Дисморфофобиялық синдром

* +Психогенді депрессия

* Үрейлі-фобиялық синдром

 

#72

*! Teenage girl, 15 years old. At the pediatrician's appointment crying, said that she "... lost the meaning of life... my mom and dad are getting a divorce... even though everything was fine before... I had complexes... I started being afraid of people... I started locking myself in my room, don't want to talk to anyone... relations with teachers became awful... and I stopped talking to my classmates, I stopped doing my homework, have poor understanding of my subjects... At home, I am constantly cursing, my father goes away, and my mother cries at night... I feel very sorry for her, and I try to help her... this has been going on for about a year now... I am also crying, it seems to me that the only thing I can do is to kill myself.....".

Determine WHAT is the first thing this patient should be treated for?

ПСИХОТЕРАПИЯ,СИОЗС

* Ипохондриялық синдром

* Эндогенді депрессия

* Дисморфофобиялық синдром

* +Адаптацияның депрессивті реакциясы

* Үрейлі-фобиялық синдром

 

#73

*! Citizen of Uzbekistan, 23 years old. Currently in Kazakhstan, tried to commit a suicide attempt by throwing himself from the 4th floor, was taken to the trauma department with a fractured femur. He told the doctor in the emergency room that he had been living in St. Petersburg for several years without Russian citizenship. After leaving the territory of the Russian Federation he was banned from entering until 2021. With tears in his eyes he said that his beloved girlfriend, with whom he had been living in a common-law marriage for three years, was staying there: "...I love her very much, it is hard for her without me... she is alone at the moment... I cannot take it anymore... I do not want to live... I want to die...".    

What is your doctor's tactic after diagnosing her mental condition? СИОЗС(МИЗОЛ) И ПСИХОТЕРАПИЯ

*+СИОЗС (мисол) және психотерапевтикалық емдеу.

*СИОЗС (мисол)

*Нейролептик (квентиакс) және психотерапевтикалық емдеу

*Транквилизатор (феназепам)

*Нормотимик (Литий карбонаты) және психотерапевтикалық емдеу

 

#74

*! Woman, 28 years old. Accompanied by her husband. Past medical history: married, two children, recently bought an apartment, good family relationships. Spouse's condition changed within a month, no apparent reason. Patient looks downcast, sad expression, sits in a bent posture. Speaks in muffled voice, speech and motor skills are slow. She said that she "... feels bad at heart, is not happy about anything... has lost 3 kg in a month, no appetite... feels unnecessary, guilty, cannot do anything at home... does not want to live, constantly thinks about suicide - children are holding her...". 

What is your medical tactics as GP in accordance with the Standards of psychiatric care in the RK?

ЖЕНЫЛ ДЕПЕРССИЛЫК ЭПИЗОД И ОТПРАВИТЬ К ПСИХОЛОГУ

* + Диагноз: «Умеренный депрессиялық эпизод» және психиатрға жолдау;

* Диагноз: «Жеңіл дәрежелі депрессиялық эпизод» және диагноз бен емдеу хаттамаларына сәйкес ем тағайындау.

* Диагноз: «Депрессивті бейімделу реакциясы, ұзаққа созылған» және психотерапевтке жолдау;

* Диагноз: «неврастения»диагнозы және емдеу хаттамаларына сәйкес емдеуді тағайындау

 

#75

*!Man, 37 years old, unemployed, has casual earnings, moonlighting as a longshoreman. After his mother's death, he had been living alone for a year, no family, no contact with anyone. He told his district therapist that "there is no desire to do anything, there is a feeling of uselessness, that all efforts are in vain and useless... there is no way out of hopeless misery... I do not understand what I live for, I do not want to live, the feeling of uselessness and hopelessness never leaves me...".

 What is your therapeutic tactic after a mental health diagnosis?

? СИОЗС(МИЗОЛ) И ПСИХОТЕРАПИЯ

*+ СИОЗС (мисол); психотерапия

*СИОЗС (мисол); нормотимик (Литий карбонаты); психотерапия

*Нейролептик (квентиакс); психотерапия

*Транквилизатор (феназепам); психотерапия

*Нормотимик (Литий карбонаты); психотерапия

 

#76

*!Woman, 63 years old. Registered with a diagnosis of discirculatory encephalopathy. Suffered a spouse's death from cancer four years ago, has two children, grandchildren, who live abroad. During her visit at the doctor's, she said that "longing for her husband does not subside, it grows with every year... I can't live without him... I can't sleep without him... I have no appetite... I don't know what to do.... I want to die...".

 What is your therapeutic tactic after the diagnosis of the mental condition?

? СИОЗС(МИЗОЛ) И ПСИХОТЕРАПИЯ,НООТРОПЫ,ПСИХОТЕРАПИЯ

Для интернов 6-го курса

05В130 1 00 "Общая медицина " направление «Врач общей практики»

 

#1

*!Пациентка Д., 44 года. Внешне выглядит запущенной и неприбранной. Выражение лица печальное. Мимика и жестикуляции бедны. В процессе беседы сидит в однообразной позе, малоподвижна. Инициативы в беседе не проявляет, ответы односложные. Говорит тихим голосом. Удалось выяснить жалобы на плохое настроение, безразличие к окружающему, чувство тоски, плохой сон, отсутствие аппетита. Считает себя недостойной внимания и сочувствия, ощущает чувство вины. К вечеру отмечает некоторое улучшение состояния - ощущение тоски уменьшается.

Какой предварительный синдромальный диагноз НАИБОЛЕЕ вероятен?

*+ Депрессивный синдром, предположительно эндогенного происхождения

* Депрессивный синдром, предположительно экзогенного происхождения

* Обессивно-фобический синдром

* Астенический синдром

* Апатический синдром

 

#2

*!Больной Ж., 37 лет. Поступает неоднократно. Предыдущие госпитализации поочередно в состоянии депрессии и мании. Интермиссии длительные. Психический статус на момент осмотра: тревожен, ажитирован. Обвиняет себя в том, что вся его "жизнь состоит из сплошных ошибок и прожита напрасно", что "отца довел до болезни", из-за него "возникли конфликты на производстве, испортились отношения в семье". Требовал, чтобы его судили. Речь монотонна, мимика страдальческая. Ухудшение состояния отмечает обычно по утрам. К вечеру становится оживленным. В разговоре с другими больными говорил, что достоин наказания, жаловался на чувство тяжести в груди, сердцебиение. Определите НАИБОЛЕЕ вероятный предположительный диагноз?

* + Биполярное аффективное расстройство, депрессивная фаза

* Параноидная шизофрения

* Соматоформное расстройство

* Кататоническая шизофрения

* Органическое эмоционально-лабильное (астеническое) расстройство

 

#3

*!В поликлинику обратилась пациентка, 38 лет с жалобами на утомляемость, отсутствие настроения, нежелания что-либо делать, отсутствия удовольствия от занятий, которые раньше ей поднимали настроения, нарушения сна. Однако пациентка с трудом, но продолжает вести повседневный образ жизни: работает, выполняет домашнюю работу. По данным объективного обследования патологии нет. Какова Ваша дальнейшая врачебная тактика как врача ВОП в соответствии со Стандартом оказания психиатрической помощи в РК?

* Дадите направление к психиатру

* + Выставите диагноз и будете лечить в соответствии с Протоколами диагностики и лечения

* Перенаправите к невропатологу

* Направите к гинекологу

 

#4

*!Больной 76 лет, плотник. Последние 3 года родственники замечают, что он стал забывать цифры,

имена, даты. Прячет свой инструмент и забывает куда положил его. Раньше был "смекалистым",

а теперь дает нелепые советы. С трудом вспоминает имена своих детей, жены, с которой прожил

50 лет. По характеру стал ворчливым, эгоистичным, подозрительным. Однако этим обстоятельством не тяготится, считает, что с памятью у него "все в порядке". Заявляет, что его обворовывают, угрожает судом. Находясь несколько месяцев в больнице, утверждает, что "вчера был дома,встречал гостей...". Грубых неврологических расстройств нет. Квалифицируйте синдром:

*Депрессивный

*Корсаковский

*Астенический

* Лакунарная деменция

*+ Тотальная деменция

 

#5

*!Пациентка, 50 лет. Обратилась в поликлинику с жалобами на сниженное настроение, необоснованную тревогу, беспокойство, плаксивость, нарушение ночного сна в течение 3-х недель. Больна в течение 4-х лет. Ранее с подобными состояниями трижды находилась на стационарном лечении в отделении психотерапии. После выписки принимала поддерживающую терапию амитриптилином 50 мг/сут, конвулексом 600 мг/сут., настроение было стабильным в течение 5 месяцев. Состояние ухудшилось после отмены препаратов, так как на их фоне отмечались выраженная сухость во рту, повышенный аппетит, набрала в весе. На приёме: Выглядит поникшей, выражение лица печальное, уголки губ опущены, сидит в унылой позе, на вопросы отвечает после некоторых пауз, немногословна. Говорит о том, что стала менее общительной, отказывается от посещения мероприятий из-за чувства «усталости», стало тяжелее справляться с привычными обязанностями. Суицидальные мысли отрицает. Во время беседы реагирует на внешние стимулы.

Какой из перечисленных диагнозов НАИБОЛЕЕ вероятен?

* Депрессивный эпизод лёгкий (F32.0)

* Органическое эмоционально лабильное (астеническое) расстройство (F06.6),

* Расстройство адаптации (F43.2)

*+ Реккурентное депрессивное расстройство (F33),

*Смешанное тревожное и депрессивное расстройство (F41.2)

 

#6

*!Женщина, М., 23 лет. Не работает, студентка второго курса ПТУ. Стаж курения девять лет, выкуривает по две пачки сигарет в день. Вышла замуж три года назад. Находится на третьем месяце беременности. Бросить курить отказывается. Муж не вмешивается, так как сам курит с 13 лет. Екатерина встала на учет в женской консультации по беременности. Не понимает, какой вред наносит своему еще не родившемуся ребенку. Оба супруга курят дома, на кухне.

Какое лечение более целесообразно при данном случае

* дезинтоксикационная терапия

*+антиникотиновая терапия, психотерапия,

* сосудистые, ноотропы

*нейролептик

*антидепрессанты

 

#7

*!Больной 60 лет, инженер. На протяжении последних лет "забывчив", выражено снижение памятина текущие события. Заметно ухудшилась сообразительность, в отчетах по работе стал делатьошибки, пропуски, появилась раздражительность, повышенная утомляемость и слабодушие.Стал постоянно записывать в блокноте имена знакомых, даты, цифры - "чтобы не путать".Вместе с тем критически относится к снижению своей работоспособности, обращался к врачамза помощью по поводу снижения памяти и сообразительности, плакал. При посещении врачей был вежливым,приветливым. Квалифицируйте синдром:

*+ Лакунарная деменция

*Психоорганический

*Корсаковский

* Астенический

*Тотальная деменция

 

#8

*!В эксперименте на просьбу объяснить пословицу «Трава всегда выглядит зеленее на другой стороне улицы» пациент отвечает: «Знаешь, парень, иногда это правда. Если знаешь, куда взглянуть — можешь поймать свое счастье. Если ты сейчас отдашь мне все свои деньги, я вложу их в дело и сделаю тебя миллионером». Темп речи ускорен, глаза блестят. Наиболее вероятный диагноз:

*недифференцированная шизофрения

*+биполярный психоз, фаза мании

*сенильная деменция

*депрессивный невроз

*биполярное расстройство, фаза депрессии

 

#9

*! Ребенка 6 лет на прием к врачу ВОП привели родители. Со слов родителей: у ребенка трудности в усвоении школьной программы с первых дней: недостаточное развитие ручного умения навыка письма и рисования, не может решать арифмитические задачи. Усвоение учебного материала не за счет понимания, а в результате механического запоминания. Овладел побуквенным чтением, может написать свое имя, фамилию и возраст. Пользуется простыми фразами для коммуникации. Словарный запас ограничен. Внимание рассеянное, во время беседы отвлекается на малейшие звуки и движения. Фон настроения приподнят. Родители описывают его внушаемость и податливость плохому влиянию. 

Какое из ниже перечисленного НАИБОЛЕЕ вероятно соответствует этому случаю?

*Расстройство рецептивной речи

* Расстройство экспрессивной речи

* Приобретенная афазия с эпилепсией

* Специфическое расстройство чтения

* + Умственная отсталость легкой степени

 

#10

*! У мальчика 5 лет, нет потребности в контактах с окружающими, безразличие к близким, неспособность дифференцировать людей и неодушевленные предметы, недостаточность реакций на зрительные и слуховые раздражители, что придает ему сходство со слепыми и глухими. На поход к врачу отреагировал криком и протестом зайти в кабинет. На приеме через некоторое время появились стереотипные движения пронации-супинации кистей.

Какое из нижеперечисленных расстройств НАИБОЛЕЕ вероятно в данном случае?

* Атипичный аутизм с умственной отсталостью

* Атипичный аутизм без умственной отсталости

* Шизотипическое расстройство

* Аутизм Аспергера

*+Детский аутизм

 

#11

*! Мальчик В, 6 лет на приеме у врача ВОП, учится в первом классе, обратились родители с жалобами на нарушение речи, при котором ребенок понимает смысл и значение слышимых им слов, умеет прочитать написанные слова, в состоянии их написать, но не может их выговорить. В ответ на вопрос он чаще всего кивает головой и жестом показывает, что ничего сказать не может, или, произнося отдельные слова, затрудняется правильно назвать предметы, действия.

 Какое из нижеперечисленных расстройств НАИБОЛЕЕ вероятно в данном случае?

* Моторная алалия

 * Сенсорная алалия

* Элективный мутизм

* + Моторная афазия

* Сенсорная афазия

 

#12

*!Мальчик 7 лет склонен к аффективным вспышкам и агрессивному поведению, грубо расстроенным вниманием (вплоть до апрозексии), своеобразной «прилипчивостью» при общении. При осмотре раздражительный, капризный, легко возбудимый по малейшему поводу. Часто аффективные вспышки возникают у него и без каких-либо видимых внешних воздействий, могут сопровождаться как агрессией, так и аутоагрессией, разрушительными действиями.

Какая из форм умственной отсталости согласно клинико-физиологической классификации НАИБОЛЕЕ вероятно соответствует этому описанию?

* атоническая

* апатическая

* стеническая 

*астеническая

*+Дисфорическая

 

#13

*! Ребенок Н, 5,5 лет на приеме у врача ВОП, занимается в нулевом классе. Обратились родители с жалобами на нарушение речи, и поведения,во время занятий не усидчив, может кинуть все предметы на пол и плакать. Из анамнеза от 1 беременности, 1 срочных родов, с весом 3100 и оценкой по Апгар 5 баллов. Акушерский анамнез отягощен (во втором триместре мать перенесла ОРВИ, асфиксия 5 минут). При общении с ребенком выявлено нарушении речи в виде дислалии. При осмотре выявлена патология языка в виде короткой уздечки и неправильного прикуса. Какова Ваша дальнейшая врачебная тактика как врача ВОП?

*Консультация логопеда, невролога

*Консультация психиатра, невролога

* + консультация психиатра, психолога, логопеда,невролога

 *консультация психолога, логопеда, невролога

* консультация логопеда, психолога

 

#14

*! Юноша 18 лет, возбужден, улыбается, многословен, болтлив, глотает слова, в беседе легко отвлекается на побочные темы, дает множество советов окружающим, предлагает свою помощь, испытывает голод, гиперсексуален. Лицо обычной окраски. Диагноз:

*маниакальный синдром

*опийное опьянение

*+гашишноео пьянение

*кокаиновое опьянение

*барбитуровое опьянение

 

#15

*!Женщина просит полечить от алкоголизма сына 23 лет. Сын с детства отличался «трудным» характером: дружил с асоциальными подростками, под их влиянием с 11 лет начал курить и принимать алкоголь. Крал у родителей деньги, будучи уличен в краже, лгал. Наиболее вероятный диагноз:

*дебильность

*+возбудимая психопатия

*неустойчивая психопатия

*паранойяльная психопатия

*неврастения

 

#16

Мужчина, 37 лет, с 20 лет злоупотребляет алкоголем. В последние годы пьет в течение суток многократно, малыми порциями. Наблюдаются снижение болевой чувствительности в нижних конечностях, нарушение походки. Не может назвать текущий день, месяц, забывает то, что происходило минуту назад. Какой из нижеперечисленных диагнозов НАИБОЛЕЕ вероятен и какой препарат необходим?

*алкоголизм 1 стадии, аминазин

*алкоголизм 2 стадии, амитриптиллин

*+алкоголизм 3 стадии, алзепил

*простое алкогольное опьянение, аминазин

*Корсаковский психоз, алзепил

 

#17

*!Что из ниже перечисленного НАИБОЛЕЕ вероятно является критерием 1-й стадии наркоманической зависимости?

*+психическое влечение к наркотикам 

* нерегулярный прием наркотика

* абстинентные проявления

* деградация личности

*симптом «плато»

 

#18

*! Что из ниже перечисленного НАИБОЛЕЕ вероятно является критерием 2-й стадии наркоманической зависимости?

* обсессивное влечение к наркотику

* дисморфоманический синдром

* прогрессирующая амнезия

*снижение толерантности

*+абстинентный синдром

 

#19

*!Что из ниже перечисленного НАИБОЛЕЕ вероятно является критерием 3-й стадии наркоманической зависимости?

*обсессивное влечение к наркотику, рост толерантности

*+изменения личности, снижение толерантности 

*сенестопатии, ипохондрические расстройства

*утрата защитного рвотного рефлекса

*симптом «плато», эйфория

 

#20

*!Подросток, девочка, 15 лет, жалуется на «приступы желания убить себя». С её слов, «при сильном волнении, радости через какое-то время возникают навязчивые мысли по типу: «Просто убей уже себя», «Ха-ха, зачем жить?». Данные мысли приносят страдание, тяготится ими: «Это невыносимо». «В какое-то время мысли проходят, но потом снова появляются. Именно в эти моменты мне хочется навредить себе. Вот просто так...не имея на это какой-либо причины… На самом деле мысли о суициде присутствуют в моей голове почти постоянно. Иногда становится страшно стоять в местах, где есть возможность покончить со своей жизнью. Единственное, что не даёт мне совершить желаемое - это родственники и важные для меня люди. Я совсем не хочу причинять боль любимым людям. Совсем не хочу заставлять их плакать. И поэтому, прошу помощи».

Какой из перечисленных синдромов наиболее вероятен?

* Бредовый синдром

* Конверсионный синдром

* Депрессивный синдром

* +Обсессивный синдром

* Тревожно-депрессивный синдром

 

For 6th year interns

05 В 130100 "General Medicine" direction "General Practitioner

Number of credits - 4

Number of tests: 1X20 = 80 tests

#1

*! Patient N., 54 years old. Seems tired and depressed. When talking, she is somewhat animated, actively and emotionally complains of headaches, head noise, dizziness, fatigue and decreased capacity for work, poor tolerance of noise and stuffiness, irascibility, tearfulness, forgetfulness, bad mood. Depending on the topic of conversation, the mood easily fluctuates from crying to smiling. Confuses dates when giving anamnestic information. Asks for help to be able to work until retirement.

Which of the following is the most likely disorder?

Астенический синдром, предположительно сосудистого происхождения (склероз сосудов головного мозга).

* Ажитирленген үрей

*+Астениялық синдром, қан тамыр тегі.

* Апатиялық депрессия

* Кандинский-Клерамбо психикалық автоматизмдер синдромы

* Маскирленген депрессия

#2

*! Patient V., 40 years old, a music teacher. By her nature, she is impressionable, mistrustful and capricious. Loves to be the center of attention of others. Considered to be a "hottie," but irritable, incivable and jealous in the family. Her condition began soon after the second birth, which was difficult and had many complications. Taking care of the child took a lot of strength. After a quarrel with her husband's relatives, she was upset, cried, spoke with affectation about her unwillingness to live. At the same time the thought arose in her mind that she was ill with cancer. She vividly and figuratively imagined a tumor in her belly, which was spreading to her internal organs. It was disintegrating, forming ulcers. She herself was frightened by these thoughts and tried to drive them away, but they continued to haunt her, causing her anxiety and fear. She turned to a general practitioner, who found any diseases of internal organs. For some time the patient calmed down, but soon the thought of possible death in severe agony arose again. At the reception, obsessive thoughts of a serious illness, of death. She understood the groundlessness of her fears, but could not get rid of them. Fears "going crazy" and staying in a psychiatric hospital for the rest of his life.

What is the most likely preliminary syndromal diagnosis?

Ipochondric syndrome

Какой предварительный синдромальный диагноз НАИБОЛЕЕ вероятен? Навязчивые ипохондрические идеи.

* Параноидты синдром

* Паранояльді синдром

* Котар синдромы

* + Ипохондриялық синдром

* Депрессивті синдром

 

 

#3

*!Patient V., age 40. During the interview she says: "I am constantly in a state of fear for my life. On the one hand, I am well aware that nothing will happen to me, and at the same time, I am afraid that any of my actions may adversely affect my health. When I walk down the street, I involuntarily start counting some things, objects, be they poles, houses, cars. When it seems to me that I have counted correctly, I calm down for a while. If for some reason I stray from counting, there is a fear that trouble awaits me. It is especially difficult at work. Having completed some task, I start to doubt whether everything was done correctly. If I find that some detail was not done properly, I immediately feel weak, palpitating, and trembling. I feel that I can't change or redo anything, and I can only wait to see how it all ends. I am constantly in a double state: I know I must work and provide for my family, but I cannot get down to work because of an intolerable feeling of fear for my health. What treatment is indicated for this patient?