Archives: Medical Student Finals

MSFinals-5593

A 45-year-old woman is brought in by her daughter because ‘she is acting wild again’. She drinks moderately about once a week. She is not sleeping much, talks incessantly about plans to travel the world and has made many impulsive and irrational purchases. She reports hearing voices but refuses to discuss this issue when questioned by the admitting psychiatrist. She begins a task but does not complete it, all the while making lists of things to be done. She has been starting tasks and not finishing them. She had a similar episode 3 years ago. She also has depressive episodes several times over the last few years and recovered in between them.
What is the most likely underlying diagnosis?

MSFinals-5594

A 32-year-old office worker presents to the Emergency Department after taking a handful of various tablets following an argument with her current partner. She has a history of tumultuous relationships and struggles to maintain friendships or romantic relationships due to this. She also admits to experiencing intense emotions, frequently oscillating between extreme happiness and anger or anxiety. In the past, she has engaged in self-harm and frequently drinks to excess. A psychiatry review is requested to evaluate the possibility of a personality disorder. What personality disorder is the most probable diagnosis for this patient?

MSFinals-5595

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-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-5562

A young adult is concerned about her ability to take her upcoming final exams at university in three months. She experiences feelings of fluster, faintness, and dizziness specifically during written exams, but has no symptoms at any other time, including during physical activity. Her resting ECG is normal and clinical examination shows no abnormalities. What is the best course of action to take?

MSFinals-5563

A 32-year-old male construction worker presents to the clinic with concerns about his recent behavior at work. Over the past week, he has been very talkative and easily distracted while on the job. This is unusual for him as he typically prefers to stay focused and get his work done efficiently. He also reports feeling more energetic than usual and needing less sleep. He denies any impulsive behavior, drug use, or sexual promiscuity. There is no significant medical history, but his father has a history of bipolar disorder.

What would be the most appropriate next step in managing this patient’s symptoms?

MSFinals-5564

A 16-year-old boy with Tourette’s syndrome is brought to the GP by his father as he is concerned about some unusual behaviors he has observed. During the appointment, you discover that he has been extremely anxious about his upcoming driving test. He feels compelled to check the locks on all the doors in the house repeatedly before leaving, as otherwise, he becomes more anxious about the test.

What signs or symptoms would suggest a diagnosis of psychosis rather than obsessive-compulsive disorder?

MSFinals-5567

A 35-year-old woman presents to her general practitioner complaining of a backache that has persisted for the last two weeks. The doctor diagnoses her with a muscle strain and recommends rest with paracetamol for pain as needed. The patient requested narcotic pain medicine, but the doctor refused to prescribe the drug because she thought a medicine of that strength was unnecessary. The patient left the examination room angrily and yelled at the reception staff on her way out.
Which of the following defence mechanisms was the patient demonstrating?

MSFinals-5568

A 27-year-old man is brought to the emergency department by police after being found naked in the street and shouting about the government’s plan to infect the population with a virus through the water supply. He is not known to secondary care services and a drug screen is negative. The psychiatry liaison team admits him under Section 2 of the Mental Health Act for assessment of a first psychosis. What is the most significant risk factor for this patient’s condition?