Med Student Finals Category: Psychiatry

MSFinals-5345

A 42-year-old man is brought to the Emergency Department by his friends. He holds a senior trading job in an investment bank and has a history of recurrent admissions following cocaine intoxication. They are worried because he recently sent a memo to everyone on the trading floor suggesting that he is now the lead, he has the mental capacity to beat anyone to a higher profit and he should be chairman of the group. In fact, he has been performing poorly and has missed recent performance targets.
Which of the following is the most likely diagnosis?

MSFinals-5346

A 29-year-old woman presents with dry, eczematous hands. She reports being a very hygienic person, but since the onset of the COVID-19 pandemic, she has been washing her hands excessively – up to 60 times a day. She is aware that this is causing her skin to become dry and irritated, but her anxiety about contracting the virus is too great to stop. She works in a hospital and is worried about her colleagues noticing her frequent hand washing. You suspect she may have obsessive-compulsive disorder and decide to refer her to the community mental health team. What treatment options are likely to be offered to her?

MSFinals-5331

A 16-year-old is brought to her General Practitioner by her parents after they noticed her eating habits had become irregular. The parents report that the patient eats large volumes of foods and is sometimes found vomiting shortly after eating dinner. This behaviour has been occurring for the past 6 months. On examination, the patient’s vital signs are normal and she has a body mass index (BMI) of 23. She has excoriations on the knuckles of her right hand. She also has erosions on her teeth and swelling bilaterally on the lateral aspects of the face along the mandibular rami.
What is the most likely diagnosis?

MSFinals-5347

A 52-year-old woman who is well known to the community mental health team is brought into the psychiatric hospital by her worried friends. She has not been eating more than a few mouthfuls of food a day for the last two weeks and refuses to speak more than a few words. She remains awake all night and rocks in her chair. She even refuses to drink more than a cupful of water per day despite numerous attempts by her friends, doctors and psychiatrists. She is refusing all oral medications. After a brief conversation, you feel she has capacity to make decisions. You learn she has a long history of depression which has been very severe at times.
Which of the following is the most appropriate treatment?

MSFinals-5332

A 72-year-old patient comes to see the General Practitioner with his daughter. She expresses concern that her father has been acting differently lately. Once the daughter leaves the room, he confides in the doctor that the woman who came with him is not his daughter, but an imposter. He firmly believes this and cannot be convinced otherwise.
What is the most probable diagnosis?

MSFinals-5333

You see a 47-year-old woman in clinic at the General Practice surgery where you are working as a Foundation Year 2 doctor. She has a diagnosis of moderate depression and would like to try an antidepressant alongside her cognitive behavioural therapy, which is due to begin in 2 weeks. She has no significant past medical history and is not on any prescribed or over-the-counter medications.
Which of the following antidepressant medications would be most appropriate as the first-line treatment?

MSFinals-5334

You are advising a 35-year-old woman with major depressive disorder who is contemplating electroconvulsive therapy (ECT).
What is a temporary side effect of this treatment?

MSFinals-5335

A 49-year-old male with schizophrenia is being evaluated by his psychiatrist. According to his family, he has become increasingly apathetic and neglectful of his personal hygiene and household chores. When asked about his behavior, he responds with statements such as it doesn’t matter and why bother? What symptom of schizophrenia is this patient exhibiting?

MSFinals-5336

You are working in a GP surgery and your next patient is John, a 35-year-old man with a diagnosis of generalised anxiety disorder (GAD). He is currently prescribed sertraline 200mg daily.

During the review of his symptoms today, John reports that he does not feel like the sertraline is helping, and he remains anxious almost all of the time. He experiences frequent episodes where he feels his heart pounding in his chest and his head is spinning. Additionally, he notes that he often struggles to get to sleep and can lie awake for hours at night.

As you observe John, he appears visibly distressed. He seems unable to sit still in his chair and is trembling slightly.

What would be the next step in John’s management?

MSFinals-5337

A 47-year-old male comes to the GP with concerns about his difficulty falling asleep. He believes that he may be suffering from chronic insomnia, which he has read about online.

The patient reports that he has attempted various methods to help him sleep, such as meditation and taking a warm bath before bed. However, he feels that he has too many thoughts racing through his mind and cannot seem to turn them off. This occurs at least three times a week and has persisted for the past month.

What indication would suggest that this individual has misdiagnosed himself?