Med Student Finals Category: Psychiatry

MSFinals-5327

A 63-year-old man presents to his general practitioner with stiffness in his muscles, difficulty initiating movements such as getting up from a chair, slow movements and hand shaking, which started 5 weeks ago. He has a medical history of schizophrenia and has had good compliance with his medication for the past 3 months. He is taking haloperidol. On examination, his temperature is 37.5 °C, blood pressure 120/81 mmHg and pulse 98 bpm. On examination, there is decreased facial expression, pill-rolling tremor, cogwheel rigidity and festinating gait.
Which of the following terms describes the symptoms of this patient?

MSFinals-5328

A 72-year-old woman, widowed for 5 years, presents with insomnia, anhedonia, frequent tearfulness when discussing her late husband, and weight loss. She reports experiencing various nonspecific physical symptoms and expresses concerns about the return of breast cancer that was previously treated. She denies any substance abuse and denies having suicidal thoughts but admits that she would feel relieved if she were to pass away. What is the most suitable form of psychotherapy/treatment for this patient?

MSFinals-5313

A 22-year-old female with paranoid schizophrenia is currently admitted as an inpatient and receiving treatment with antipsychotic medication under section 3 of the Mental Health Act. She has recently reported experiencing breast tenderness and enlargement. As the current antipsychotic regimen is not being well-tolerated, what would be the most suitable alternative antipsychotic medication to minimize these side effects?

MSFinals-5314

A 32-year-old woman presents to her GP for her 6-week postnatal check-up. She mentions feeling mildly depressed at times but denies any issues with her eating or sleeping habits. She is managing well with taking care of her baby and has a strong support system from her loved ones. She is currently breastfeeding.
What would be the most suitable course of action for her management?

MSFinals-5315

A 29-year-old man is admitted to a medical ward for treatment of an abscess in his leg. He has a history of intravenous heroin use and reports that he is beginning to experience symptoms of opioid withdrawal. What is the most appropriate course of action for this patient?

MSFinals-5302

During an out of hours shift, you are called to see an 80-year-old man who has developed acute urinary retention on a background of 3 years of urinary hesitancy and poor stream. He has a history of ischaemic heart disease, hypertension and he tells you that his usual GP has recently started him on a new medication for neuropathic pain. Which of the following drugs is most likely to have precipitated the urinary retention?

MSFinals-5303

A 25-year-old man presents to the Emergency Department in a distressed state. He says he hears voices telling him that he is worthless and that the people talking to him know what he is doing as they are listening to his thoughts via the television and radio. His friends who attend with him tell you that he has become withdrawn over the past few months and has been missing lectures. There is a history of cannabis use but nil else of note. When he talks to you, he appears to have constructed a number of new words to describe the machines used to listen to him.
Investigations:
Investigation Result Normal value
Haemoglobin 139 g/l 135–175 g/l
White cell count (WCC) 6.1 × 109/l 4–11 × 109/l
Platelets 294 × 109/l 150–400 × 109/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l
Potassium (K+) 4.3 mmol/l 3.5–5.0 mmol/l
Creatinine 100 μmol/l 50–120 µmol/l
Alanine aminotransferase (ALT) 34 IU/l 5–30 IU/l
Bilirubin 16 μmol/l 2–17 µmol/l
Which of the following is the most likely diagnosis?

MSFinals-5304

An 18-year-old boy takes an overdose of 12 paracetamol tablets after a fight with his best friend. He is found by his roommate and rushed to the hospital.

What is the most significant factor that suggests a high likelihood of a successful suicide attempt?

MSFinals-5305

A 22-year-old university student has been advised to see her General Practitioner by teaching staff who are very concerned that she has lost a lot of weight throughout the term. She has lost 10 kg over the last six weeks but does not see any problem with this.
Which of the following is a diagnostic criterion for anorexia nervosa (according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V))?

MSFinals-5306

A 50-year-old male with schizophrenia is evaluated by his psychiatrist, who has been his doctor for more than a decade. During the consultation, the psychiatrist observes that the patient provides brief responses to all inquiries and appears to lack the spontaneous speech that would typically accompany such a response. For instance, when asked How have your grandchildren been since I last saw you?, the patient replies, Fine. Later on, the psychiatrist inquires, Which of your grandchildren are doing well? The patient responds, Samantha. It takes several more questions to determine that Samantha has been excelling in school and has recently won an award.

Which symptom of schizophrenia is the patient exhibiting?