Severe Mental Illness Practice Questions

Q: A 58-year-old man presents with progressive memory loss and behavioral changes over 10 months. MRI shows asymmetric frontotemporal atrophy. What is the most appropriate symptomatic treatment?

Supportive care only. ***Supportive care only*** - Frontotemporal dementia (FTD), characterized by **progressive memory loss**, **behavioral changes**, and **asymmetric frontotemporal atrophy** on MRI, currently lacks disease-modifying treatments. - Management focuses on **supportive care**, including symptom management for agitation, sleep disturbances, and nutritional needs, alongside comprehensive caregiver support. *Cholinesterase inhibitors* - These medications, like donepezil or rivastigmine, are primarily used in **Alzheimer's disease** to enhance cholinergic neurotransmission. - They are generally **ineffective** in FTD and can potentially worsen behavioral symptoms in some patients. *Memantine* - Memantine is an **NMDA receptor antagonist** approved for moderate to severe **Alzheimer's disease**. - Its efficacy in FTD has **not been established**, and it is typically not recommended as a primary symptomatic treatment. *Antipsychotics for behavior* - While **antipsychotics** can be used cautiously to manage severe behavioral disturbances like aggression or psychosis in FTD, they are not a primary symptomatic treatment for the core disease process. - Their use carries **significant risks**, including increased mortality in elderly dementia patients, and should be reserved for severe, refractory symptoms. *Antidepressants* - **Antidepressants** may be used to address co-occurring **mood symptoms** such as depression or anxiety, which can be present in FTD. - They do not directly treat the core cognitive or behavioral aspects of FTD and are not considered a primary symptomatic treatment for the dementia itself.

Q: A 70-year-old man presents with confusion, agitation, and visual hallucinations that fluctuate throughout the day. He has a shuffling gait and mild tremor. His daughter reports he often falls asleep during conversations. What is the most likely diagnosis?

Lewy body dementia. ***Lewy body dementia***- The combination of **fluctuating cognition** (confusion, agitation, falling asleep during conversations), recurrent, well-formed **visual hallucinations**, and spontaneous **parkinsonism** (shuffling gait, mild tremor) is the classic diagnostic triad for Lewy body dementia.- It is characterized by the accumulation of **alpha-synuclein** protein deposits (Lewy bodies) in neurons, affecting both cognitive and motor functions.*Alzheimer's disease*- Typically presents with **insidious onset** of **progressive memory impairment** as the predominant symptom, rather than prominent fluctuations or early hallucinations.- Motor symptoms like parkinsonism appear very late, if at all, and are not core diagnostic features of early Alzheimer's.*Vascular dementia*- Cognitive decline often occurs in a **stepwise** fashion, frequently associated with a history of **cerebral vascular events** (strokes) or risk factors.- While gait disturbance is common, florid visual hallucinations and dramatic cognitive fluctuations are not typical or primary features of pure vascular dementia.*Frontotemporal dementia*- Primarily involves early changes in **personality**, **behavior** (e.g., disinhibition, apathy), or **language deficits**, often with executive dysfunction.- Lacks the characteristic combination of prominent visual hallucinations, rapid cognitive fluctuations, and parkinsonism seen in this patient.*Delirium*- Delirium is an **acute** and usually reversible disturbance in attention and consciousness, often triggered by underlying medical illness, infection, or medication.- While fluctuations and agitation are present, the patient's history describes chronic, progressive features consistent with a **dementia syndrome**, not an acute confusional state.

Q: A 27-year-old woman presents with amenorrhea, weight loss, and excessive exercise. She has fine lanugo hair and her BMI is 16 kg/m². She denies having an eating disorder. What is the most likely diagnosis?

Anorexia nervosa. ***Anorexia nervosa***- The triad of significantly **low BMI** (<17.5 kg/m² indicating severe restriction), **amenorrhea** due to HPO axis suppression, and **lanugo hair** (a compensatory mechanism for body temperature regulation in starvation) is highly specific for anorexia nervosa.- The presence of excessive exercise alongside severe weight loss strongly indicates the behavioral pathology of this disorder, even with the patient's denial, which is common.*Hyperthyroidism*- Although hyperthyroidism causes weight loss, it is typically accompanied by symptoms like **tachycardia**, **tremors**, goiter, and heat intolerance, which are absent here.- Hyperthyroidism does not cause the development of **lanugo hair**, which is a sign of chronic severe malnutrition.*Depression*- Depression can cause weight change and sometimes secondary amenorrhea, but it lacks the specific combination of the **low BMI**, excessive exercise, and physiological signs of starvation like **lanugo hair**.- The focus on weight-related behaviors (excessive exercise) points primarily toward an **eating disorder** rather than an isolated mood disorder.*Celiac disease*- Celiac disease leads to weight loss primarily through **malabsorption**, often associated with GI symptoms like chronic diarrhea or abdominal pain.- It does not explain the behavioral feature of **excessive exercise** or the dermatological finding of **lanugo hair** due strictly to gluten intolerance.*Addison's disease*- Addison's disease causes weight loss and fatigue but is classically characterized by **hyperpigmentation** (primary adrenal insufficiency) and volume depletion.- It does not typically present with the specific severe **malnutrition** signs (BMI 16, lanugo hair) or the core psychopathology of restricted intake and **excessive exercise** seen in this patient.

Question 1

A 58-year-old man presents with progressive memory loss and behavioral changes over 10 months. MRI shows asymmetric frontotemporal atrophy. What is the most appropriate symptomatic treatment?

Accepted Answer

Supportive care only

Answer

Cholinesterase inhibitors

Answer

Memantine

Answer

Antipsychotics for behavior

Answer

Antidepressants

Question 2

A 68-year-old man presents with progressive memory loss and parkinsonism. He has visual hallucinations and fluctuating cognition. What is the most likely diagnosis?

Accepted Answer

Lewy body dementia

Answer

Alzheimer's disease

Answer

Parkinson's disease dementia

Answer

Vascular dementia

Answer

Frontotemporal dementia

Question 3

A 70-year-old man presents with confusion, agitation, and visual hallucinations that fluctuate throughout the day. He has a shuffling gait and mild tremor. His daughter reports he often falls asleep during conversations. What is the most likely diagnosis?

Accepted Answer

Lewy body dementia

Answer

Alzheimer's disease

Answer

Vascular dementia

Answer

Frontotemporal dementia

Answer

Delirium

Question 4

A 78-year-old man presents with confusion and falls. His wife reports he has been increasingly forgetful over the past year. MMSE score is 18/30. What is the most appropriate initial investigation?

Accepted Answer

CT head

Answer

MRI brain

Answer

Lumbar puncture

Answer

EEG

Answer

PET scan

Question 5

A 27-year-old woman presents with amenorrhea, weight loss, and excessive exercise. She has fine lanugo hair and her BMI is 16 kg/m². She denies having an eating disorder. What is the most likely diagnosis?

Accepted Answer

Anorexia nervosa

Answer

Hyperthyroidism

Answer

Depression

Answer

Celiac disease

Answer

Addison's disease

Severe Mental Illness — MCQs

Severe Mental Illness — MCQs

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