A 50-year-old male presents to the clinic with symptoms of low mood, anhedonia, and anergia. During the mental state examination, the patient exhibits passive suicidal ideation, psychomotor agitation, and poverty of thought. It is noted that the patient was recently prescribed a new medication for the treatment of Huntington’s chorea.
Which medication could be responsible for the patient’s current presentation?
A 75-year-old man presents to his GP with a history of unsteady gait. He reports a gradual deterioration in his gait over the past few months and has had multiple falls. His wife has noticed a decline in his concentration and immediate memory, as well as irritability and emotional blunting. He was initially diagnosed with depression and started on citalopram, but with little improvement. He has a medical history of benign prostatic hypertrophy and hypertension treated with bendroflumethiazide.
On examination, he appears thin and easily distractible with marked perseveration. His mini-mental state examination score is 21/30 with deficiencies in executive function and naming. Bilateral palmomental reflexes are present, but cranial nerve and upper limb examination are normal. Lower limb examination reveals a gait apraxia. Cardiovascular, respiratory, and abdominal examinations are unremarkable, but he has been incontinent of urine.
A lumbar puncture is performed, and the results are as follows: opening pressure 19 cmH2O, CSF protein 0.45 g/L (0.15-0.45), CSF white cell count 4 cells per ml (<5 cells), CSF red cell count 1 cell per ml (<5), and CSF glucose 3.5 mmol/L (3.3-4.4). What is the most likely diagnosis for this 75-year-old patient?
A 32-year-old professional has been referred due to excessive drinking for the past two weeks. He has been feeling low for about a month, frequently crying and lacking interest in both work and sex. He acknowledges having experienced similar low periods in the last decade. However, he also describes having phases of high energy, during which he is sociable, productive, and positive. He claims to abstain from alcohol during these times. What is the probable diagnosis?
A 50-year-old man is being seen at the psychiatric clinic after being referred by his GP who has been struggling to manage his depression. The patient has a medical history of hypertension, high cholesterol, a previous acute coronary syndrome one year ago, and depression. He reports that his mood has deteriorated and he is experiencing persistent suicidal thoughts, to the extent that he is afraid he may act on them. He denies any cognitive impairment, concentration difficulties, or sleep disturbances. What guidance should be provided to him regarding driving?
You are requested to evaluate a 35-year-old woman who is presenting with symptoms of emotional distress. She reports experiencing intense anxiety and fear for the past eight months, accompanied by palpitations, tremors, sweating, and a sensation of suffocation. There is no identifiable trigger for these episodes, which typically last for 10-15 minutes and can occur in various settings, including when she is at rest. However, they are most frequent when she is riding on an escalator. She has no signs of psychosis. She has visited the Emergency department twice, believing she was having a heart attack, but all tests were normal. She had similar episodes five years ago, which gradually resolved. Her mother had a history of depression, and her father died of a heart attack at the age of 45. Her overall physical health is good, and she is alert and oriented. Her cognitive abilities are intact, except for mild difficulty concentrating. What is the diagnosis?
A 19-year-old man is being reviewed before discharge from the Neurology Ward. He was admitted electively for the second time for video and EEG telemetry to characterize witnessed seizures. His mother shows a home video of him behaving irrationally, pacing, and then falling to the floor. He shakes all four limbs and then suddenly stops. He remains groggy for several hours following the event and has been hospitalized on at least five occasions. These events happen at least three times per week, but none have been captured by video telemetry or EEG during his 5-day admission. He has no family history of epilepsy, although his mother is diabetic.
Clinical examination is unremarkable, and an MRI head has shown no intracranial or localizing lesions. Blood tests recorded at a recent Emergency Department presentation are within normal limits.
What is the next appropriate management step?
A 42-year-old accountant presents with an acute inferior myocardial infarction and is urgently scheduled for percutaneous coronary intervention (PCI). He has a history of smoking 30 cigarettes a day and hypercholesterolaemia. He occasionally drinks alcohol but denies any drug use.
The next day, he experiences restlessness, rapid heartbeat, and excessive sweating. His blood pressure is 160/75 mmHg, with a pulse rate of 110 and regular rhythm. Although his ECG does not show any new ischaemic changes, there is significant baseline interference due to the development of a tremor.
What is the appropriate course of action for his management?
A 32-year-old male comes to the clinic complaining of difficulty leaving his house due to fear of being in situations where he cannot escape, such as busy places like shopping malls and public transport. However, he reports functioning well at home and work, both in terms of productivity and interpersonal relationships.
What is the probable diagnosis?
You are requested to evaluate a 35-year-old woman who is experiencing emotional turmoil. She reports having episodes of intense anxiety and fear for the past eight months, accompanied by palpitations, tremors, sweating, and a sensation of suffocation. She cannot identify any specific trigger for her symptoms. These episodes, which typically last 10-15 minutes, occur in various situations, including when she is at ease. However, they are most frequent when she is riding on an escalator. She has no psychotic symptoms and has visited the emergency department twice, believing she was having a heart attack, but all tests were normal. She had similar episodes five years ago, which gradually resolved. Her mother had depression, and her father died of a heart attack at the age of 45. She is in good overall physical health, alert and oriented, with only minor concentration difficulties and intact cognitive abilities. Which brain region is most likely involved in this patient’s condition?
A 35-year-old female presents to the Emergency department with sharp, stabbing abdominal pain that has been present for several days. She reports feeling nauseated but has not vomited and has not noticed any changes in bowel or urinary habits. Her periods are irregular but not heavy, and her last period was two weeks ago. She had previously attended another hospital where she underwent various investigations, including an ultrasound of the abdomen, which all came back normal. However, she believed that the staff were incompetent and that something was amiss, resulting in her being escorted out of the hospital by security due to aggressive outbursts. On examination, she appeared cooperative and animated, with multiple recent scars across her abdomen and left arm. She occasionally takes cocaine and drinks 20 units of alcohol per week, and she lives with her boyfriend and is unemployed. Her vital signs are normal, and her tests show a haemoglobin level of 155 g/L, mean cell volume of 95 fL, white cell count of 6.1 ×109/L, platelets of 202 ×109/L, serum sodium of 139 mmol/L, serum potassium of 4.2 mmol/L, serum urea of 4.9 mmol/L, and serum creatinine of 78 µmol/L. What does this patient exhibit?