DAMS PSYCHIATRY 2022 CLINICAL VIGNETTES SAMPLE CASES FOR PRACTICE Case 1: A 51-year-old woman presents to her primary care physician because she is disturbingly anxious about everything. She is unable to identify a precipitating event or particular concern. She worries about her family, health, and finances. She has little respite and is frequently irritable, tired, and unable to concentrate. She has been a lifelong “worrier,” but the symptoms have become so intense in the past 6 months that she thinks she may have to stop working. Case 2) A 24-year-old woman comes to the psychiatrist with a 2-month history of short episodes of “feeling like I am going to die.” During these episodes, she also notes feelings of dizziness and nausea, along with a feeling of choking. She describes these episodes as very frightening and she is terrified of having another. She denies substance use of any medical problems. Case 3) A 34-year-old secretary climbs 12 flights of stairs every day to reach her office because she is terrified by the thought of being trapped in the elevator. She has never had any traumatic event occur in an elevator; nonetheless, she has been terrified of them since childhood. Case 4) A middle aged person reported to Psychiatry OPD with the complaints of the fear of leaving home, fear of travelling alone and fear of being in a crowd. He develops marked anxiety with palpitations and swelling if he is in any of these situations and avoids public transport to go to his place of work. Case 5) A 12-year-old boy is very distraught because every time he thinks or hears the word God or passes in front of a church, swear words pop into his mind against his will. He also feels compelled to repeat the end of every sentence twice and to count to 20 before answering any question. If he is interrupted, he has to start from the beginning. Case 6: A patient with complaints of having a deformed nose. He has visited several plastic surgeons but they have assured that there is nothing wrong with his nose. In spite of these reassurances, he continues to believe that his nose is deformed, He also complains that nobody takes him seriously because of the deformity of his nose, and he is extremely embarrassed because of this. Case 7. A 35 year old man presents to psychiatry OPD, he has a history of RTA 2 months back with multiple bone fractures. He recovered physically, but for last one and half months, he has been having sleep disturbances with dreams in which the incident of accident was getting repeated and he wakes up often feeling anxious. Also he used to get startled while walking on road hearing the sounds of vehicles Case 8: A 45-years-old woman comes to the psychiatrist requesting help in coping with her life. The patient states both of her parents have recently been diagnosed with cancer and her husband has just instituted divorce proceedings. She states she feels overwhelmed and anxious, with bouts of crying and panic attacks. Case 9. A 35 year old male, with pre-morbid anxious traits and heavy smoker, believes that he has been suffering from 'lung carcinoma' for a year. No significant clinical finding is detected on examination and investigations. He continues to stick to his belief despite evidence to the contrary. In the process, he has spent a huge amount of These cases are sample questions of different scenarios, student must try to practice making a diagnosis himself about these in class itself. No separate answer key is available. Dr. Sachin Arora, Psychiatry Faculty, DAMS DAMS PSYCHIATRY 2022 CLINICAL VIGNETTES SAMPLE CASES FOR PRACTICE money, time and energy in getting himself unduly investigated. Case 10) A 29-year-old man is brought to the emergency room by his wife after he woke up with paralysis of his right arm. The patient reports that the day before, he had gotten into a verbal altercation with his mother over her intrusiveness in his life. The patient notes that he has always had mixed feelings about his mother, but that people should always respect their mothers above all else. Case 11) A 65-year-old man, who had been hospitalized for an acute pneumonia 3 days previously, begins screaming for his nurse, stating that “there are people in the room out to get me.” He then gets out of bed and begins pulling out his IV line. On examination, he alternates between agitation and somnolence. He is not oriented to time or place. His vital signs are as follows: pulse, 126 beats per minute; respiration, 32 breaths per minute; blood pressure (BP), 80/58; temperature, 39.2°C (102.5°F). Case 12) A 65-year-old male is brought to the outpatient clinic with one year illness characterized by marked forgetfulness, visual hallucinations, suspiciousness, personality decline, poor self care and progressive deterioration in his condition. His Mini Mental Status Examination (MMSE) Score is 10. IDENTIFY THE PERSONALITY DISORDER Case 13) A 52-year-old man is sent to see a psychiatrist after he is disciplined at his job because he consistently turns in his assignments late. He insists that he is not about to turn in anything until it is “perfect, unlike all of my colleagues.” He has few friends because he annoys them with his demands for “precise timeliness” and because of his lack of emotional warmth. This has been a lifelong pattern for the patient, though he refuses to believe the problems have anything to do with his personal behavior. Case 14) A demanding 25-year-old woman begins psychotherapy stating that she is both desperate and bored. She reports that for the past 5 or 6 years she has experienced periodic anxiety and depression and has made several suicidal gestures. She also reports a variety of impulsive and selfdefeating behaviors and sexual promiscuity. She wonders if she might be a lesbian, though most of her sexual experiences have been with men. She has abruptly terminated two previous attempts at psychotherapy. In both cases she was enraged at the therapist because he was unwilling to prescribe anxiolytic medications. Case 15) A 65-year-old woman lives alone in a dilapidated house, although her family members have tried in vain to move her to a better dwelling. She wears odd and out-offashion clothes and rummages in the garbage cans of her neighbors to look for redeemable cans and bottles. She is very suspicious of her neighbors. She was convinced that her neighbors were plotting against her life for a brief time after she was mugged and thrown onto the pavement by a teenager, but now thinks that this is not the case. She believes in the “power of crystals to protect me” and has them strewn haphazardly throughout her house. For queries Email id psychiqueries@gmail.com Facebook group : “DAMS EXCLUSIVE CLUB 2022” and tag “Dr Sachin Arora” These cases are sample questions of different scenarios, student must try to practice making a diagnosis himself about these in class itself. No separate answer key is available. Dr. Sachin Arora, Psychiatry Faculty, DAMS