Med Student Finals Category: Psychiatry

MSFinals-5394

A 42-year-old woman presents to her GP with concerns about symptoms that have been affecting her for several years but are now becoming more disruptive to her daily life. She has been experiencing obsessive thoughts about her loved ones being harmed and feels compelled to perform certain rituals to prevent this from happening. She spends hours each day checking and rechecking that appliances are turned off and doors are locked. Her relationships are suffering, and she is struggling to maintain her job. She is hesitant to take medication but is open to exploring other treatment options.
What is the most appropriate psychological approach for managing OCD in this case?

MSFinals-5395

A 25-year-old woman comes to her doctor with concerning symptoms. Ten weeks ago, she was in a serious car accident. Despite being physically fine, she has been experiencing flashbacks, heightened alertness when crossing the street, and difficulty concentrating at work. What characteristic would most strongly support the probable diagnosis?

MSFinals-5396

A 28-year-old woman experiences chest pain following an argument with her 16-year-old daughter. She is brought to your clinic for evaluation. Upon examination, she appears anxious and is hyperventilating. She exhibits tenderness to light pressure on the front of her chest, but her oxygen saturation is 99% while breathing room air. An ECG reveals no abnormalities. What is the most suitable course of action for this patient?

MSFinals-5397

A 28-year-old man presents to his GP with ongoing sleep issues due to tension in his relationship with his girlfriend. He feels she is distant and suspects she is spending time with her ex-boyfriend who works in the same office. Upon further questioning, he reveals a history of feeling uninterested in past relationships and struggles with mood swings. He expresses feeling alone in the world and that even his friends are against him. Although he self-harms, he denies any suicidal thoughts. A referral to psychiatry leads to a diagnosis of borderline personality disorder. What is the most appropriate treatment for this patient?

MSFinals-5382

A 55-year-old man visits his GP clinic complaining of chronic constipation that has persisted for several years. He reveals that he has not had a bowel movement in ten days. The patient has a medical history of atrial fibrillation, type II diabetes mellitus, gastro-oesophageal reflux disease, and paranoid schizophrenia. He is currently taking apixaban, clozapine, digoxin, metformin, and lansoprazole. During the physical examination, the doctor notes a hard, non-tender abdomen and fecal impaction upon PR examination. Which of the medications listed above is likely contributing to his long-standing constipation?

MSFinals-5398

A 28-year-old man presents to his primary care physician with concerns about recurring thoughts. He has been experiencing thoughts of needing to repeatedly check that his car is locked when leaving it, even though he knows he locked it. Sometimes he feels the need to physically check the car, but other times it is just thoughts. He denies any symptoms of depression or psychosis and has no significant medical or family history. He is not taking any medications. What is the recommended first-line treatment for his likely diagnosis?

MSFinals-5383

A 56-year-old man presents with a range of physical symptoms that have been ongoing for the past 7 years. Despite multiple investigations and consultations with various specialists, no organic cause has been found for his symptoms. What is the most likely diagnosis for this patient?

MSFinals-5384

A 29-year-old man experiences a sudden emergence of auditory hallucinations describing his actions. He also firmly believes that he has been chosen by a divine entity as a prophet, which contradicts his religious convictions. During the mental state examination, the patient exhibits tangentiality and clanging. After a fortnight, the patient’s symptoms disappear entirely. The patient had a history of depression during his late adolescence, but no prior comparable incidents. What disorder did this patient have?

MSFinals-5385

A 32-year-old man is found talking incoherently, confused and aggressive outside the local shopping centre late at night. Apparently, he has attended the Emergency Department on two previous occasions, one when he made a number of cuts to his forearms with a knife, and another when he was drunk and disorderly. When you question him in the Emergency Department, he tells you that he is a spy, that the TVs in the local department store are reading his thoughts and that voices are telling him to kill his mother as she is informing on him. He mentions that this has been going on for two months. He rambles when you talk to him and seems to have created a number of new words to describe his mission.
Investigations:
Investigation Result Normal value
Haemoglobin 131 g/l 135–175 g/l
White cell count (WCC) 7.6 × 109/l 4–11 × 109/l
Platelets 203 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Creatinine 130 µmol/l 50–120 µmol/l
Alanine aminotransferase (ALT) 25 IU/l 5–30 IU/l
Bilirubin 31 µmol/l 2–17 µmol/l
Which of the following is the most likely diagnosis?

MSFinals-5386

A 42-year-old man presents to his GP with a sense of sadness and emptiness. He lost his job 8 months ago and has been struggling to focus on his daily activities ever since. ‘I’m just not the same person I used to be,’ he tells the doctor. He has no interest in finding a new job and spends most of his time at home. He denies any thoughts of suicide. His sleep is disturbed and he wakes up feeling tired. He also reports a decreased interest in sex with his partner. His medical history is significant only for a bilateral hand tremor that worsens with movement. He is a non-smoker and only drinks socially. What is the most likely diagnosis?