A 25-year-old woman comes to the emergency department with suicidal ideation after a fight with her partner. She has a history of relationship problems and frequently argues with loved ones. She denies having any paranoid thoughts or unusual beliefs but reports hearing a voice in her head that describes her negative thoughts. Upon examination, you observe several superficial scars on her forearms. There is no evidence of delusions or abnormal speech. What is the most probable diagnosis?
MSFinals-5596
A 28-year-old man who works as a software engineer has recently been terminated by his supervisor, citing missed deadlines and a decline in the quality of his work. He disputes this and claims that his supervisor has always had a personal vendetta against him. He has confided in his family and close friends, but despite their reassurances, he believes that some of his colleagues were colluding with his supervisor to oust him. During his mental health evaluation, he appears to be generally stable, except for his fixation on his supervisor and coworkers conspiring against him. His family reports that he is easily offended and has a tendency to believe in conspiracies. What is the most probable diagnosis?
MSFinals-5581
A 28-year-old woman is currently on 40 mg fluoxetine for her depression but is planning to conceive. Her psychiatrist has recommended switching to sertraline. What is the appropriate regimen for transitioning from one selective serotonin reuptake inhibitor (SSRI) to another?
MSFinals-5597
A 23-year-old man is brought to your clinic by his family for assessment. The patient recently graduated from university and has been struggling to adjust to post-graduate life. His family notes that he has always been a solitary person, preferring to spend his time in his room, playing video games and building models of his favourite characters. They had hoped that graduating from university would help him become more social. However, he has not made any new friends, and only his family is concerned about this. Instead of socializing, he continues to play video games alone in his room.
During the interview, he appears withdrawn and quiet. His emotional range is limited, and he does not show any clear signs of happiness or joy when discussing activities that he claims to enjoy. He denies experiencing any auditory or visual hallucinations and has no intention of harming himself or others. He claims that his sleep, appetite, energy, and concentration have not changed.
What is the most probable diagnosis for this patient?
MSFinals-5582
A 26-year-old individual visits their GP with symptoms of flashbacks, nightmares, and difficulty relaxing after being involved in a pub brawl 3 weeks ago. The patient has no significant medical history and has attempted breathing exercises to alleviate their symptoms without success. What is the most suitable course of action for managing this patient?
MSFinals-5583
Sophie, a 22-year-old student, presents to her GP with a history of low mood lasting several months. She is struggling with her university studies due to poor concentration and constant fatigue. Despite waking up early every morning, she finds it difficult to fall back asleep. Sophie no longer enjoys spending time with her loved ones and feels hopeless about her future. She has sought medical attention as her symptoms are significantly impacting her academic performance.
Sophie denies having any suicidal thoughts, and there is no evidence of psychotic features during the examination. She is in good health and denies any alcohol or drug use. Sophie is eager to begin treatment for her symptoms. What would be the most appropriate course of action?
MSFinals-5584
A 59-year-old man is admitted with pneumonia. He drinks 25 units of alcohol per day. His liver function is normal.
After 12 hours of admission, he suddenly becomes unwell. His vital signs are as follows: – Respiratory rate: 18 breaths/minute – Oxygen saturations: 96% – Blood pressure: 123/76 mmHg – Heart rate: 106 bpm – Capillary blood glucose: 4.1 mmol/L
An ECG shows sinus tachycardia at a rate of 103 bpm. Upon examination, he appears tremulous and sweaty and complains of feeling anxious.
What is the most appropriate course of action?
MSFinals-5585
A 32-year-old woman is brought to the edge of a roof by a trained practitioner and then left there for as long as possible until she overcomes her phobia of heights.
What sort of behavioural therapy is this?
MSFinals-5570
A 28-year-old woman comes to her doctor with a similar complaint of anxiety that has been affecting her sleep and social interactions for several months. She reports feeling restless and agitated but denies any panic attacks. Her medical history is unremarkable. What would be the best initial approach to address her symptoms?
MSFinals-5571
A 68-year-old woman visits her GP and complains of constant worrying, difficulty sleeping, and lack of focus on activities she used to enjoy. She is prescribed a new medication and referred for CBT. After a month, she returns to her GP feeling weak, lethargic, and experiencing muscle cramps. Her blood tests reveal the following results: Sodium: 126 mmol/l (normal range: 135-145 mmol/l) Potassium: 3.7 mmol/l (normal range: 3.5-5.0 mmol/l) Creatinine: 95 µmol/l (normal range: 68-98 µmol/l) Calcium: 2.40 mmol/l (normal range: 2.05-2.60 mmol/l) Phosphate: 1.41 mmol/l (normal range: 0.8-1.50 mmol/l) Which medication is most likely responsible for her symptoms?