Med Student Finals Category: Psychiatry

MSFinals-5391

You’re on an acute take ward and you are asked to see a patient by your foundation doctor. The foundation doctor is concerned about this patient as he is uncertain of the next step in management and investigation.
The patient is a 46-year-old male who has been admitted with excess tearing. He has a past medical history of allergic rhinitis. He uses nasal saline rinses several times a day. His father recently died of lung cancer with brain metastases.
This patient has had extensive investigations in multiple other hospitals due to his concerns of a cancer diagnosis causing his excessively watery eyes. He has had three CT orbits in the last 12 months which have been reported as normal. On ophthalmic examination, he has some crusting and erythema of his lid margins, but it is a normal examination otherwise. The patient remains convinced that a cancer diagnosis still can’t be excluded.
What is the reason for this patient’s presentation?

MSFinals-5392

A 20-year-old woman presents to her General Practitioner (GP) with a 2-year history of restricting food intake and self-induced vomiting. She attends her GP for the first time with her sibling reporting a recent worsening of her symptoms. The GP suspects anorexia nervosa.
Which is the most appropriate investigation to determine whether the patient requires urgent hospital admission?

MSFinals-5393

A 32-year-old female presents to her primary care physician with her sister. The sister is worried that the patient may have a personality disorder due to her lack of interest in socializing and her preference for being alone. Upon further discussion, the patient admits to having no desire for romantic relationships, being unemployed, and lacking motivation to work. She denies any self-harm or suicidal thoughts and has no history of legal issues. During the consultation, she displays a flat and emotionless facial expression. What personality disorder is most likely present in this patient?

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-5365

A patient is brought to see you by his daughter. She is very concerned about him, saying that over the last few weeks, he has been hiding himself in their bedroom, heard to be talking to himself and accusing her of stealing his secret work and selling it to the government.
You conduct a mental state examination and elicit the following symptoms.
Which of these symptoms is a negative symptom?

MSFinals-5381

A 35-year-old unemployed man visits his GP seeking assistance with his heroin addiction. He has been using heroin for more than a year after a friend suggested trying the drug after a night out. As a result, he has frequently used heroin. He has lost his job, ended his long-term relationship, and is currently sleeping on his friend’s couch.

A few months ago, he attempted to quit because he wanted to turn his life around, but he found the withdrawal symptoms too difficult to handle and ended up using heroin again. He is eager to try and quit drugs, but he feels he cannot do it without some form of assistance.

Which of the following can be used for substitution therapy in opioid-dependent patients?

MSFinals-5366

A 27-year-old woman is brought to the Emergency Department by her father after attempting suicide with an overdose of medication. Upon questioning, she says that she has recently broken up with her boyfriend and that he does not let her use cocaine and marijuana. This is the second time that they have broken up, and she tells you that she fights constantly with him. Hospital records show that she has been admitted to hospital many times and that she has had many previous suicide attempts. She admits to drinking heavily at weekends and to having had unprotected sex with multiple partners over the last year.
Which one of the following personality disorders best describes this patient?

MSFinals-5367

A young man arrives at the emergency department after taking a paracetamol overdose following a recent break-up. He has since entered into a new relationship, but is struggling with frequent outbursts of anger. The patient has a history of childhood abuse and struggles with maintaining healthy relationships. He reports experiencing frequent mood swings between low and elevated states. The overdose was not premeditated and the patient has a history of similar incidents. What is the most probable diagnosis?