A 38-year-old woman who has often presented with various physical complaints is diagnosed with generalised anxiety disorder. Despite receiving low intensity psychological interventions, her symptoms remain unchanged. What medication would be the most suitable next step in her treatment?
A 75-year-old male comes in for his routine check-up without specific concerns. During the examination, no abnormalities were detected. However, upon reviewing the blood test results sent by the nurse before the appointment, the following values were noted:
Na+ 130 mmol/l
K+ 3.5 mmol/l
Urea 4 mmol/l
Creatinine 85 µmol/l
The patient’s medications are now being reviewed. Which medication is the most probable cause of the electrolyte abnormality?
A 7-year-old boy and his mother die in a car crash. Following these deaths, the boy’s 16-year-old brother starts playing with the dead boy’s toys.
This would most likely be an example of which of the following defence mechanisms?
A 70-year-old man contacts his primary care physician for guidance. He lost his wife to cancer and has been a widower for 6 months. The patient has a supportive family and is not experiencing clinical depression, but he was very emotional after his wife’s passing. He occasionally feels indifferent and disheartened, but this has improved significantly over time. However, he has heard his late wife speaking to him on several occasions over the last 2 weeks. He also believed he saw her once while shopping with a friend, but he acknowledges that this is impossible. What is the most appropriate course of action for management?
A 65-year-old Asian woman presents with sudden onset paranoid thoughts and suicidal ideation. She has a medical history of hypertension, type 2 diabetes mellitus, and hypercholesterolemia. Given her age and first episode of psychosis, what crucial investigation is necessary to rule out other potential underlying causes?
A 32-year-old woman visits her GP for a follow-up on her depression. She is experiencing mild to moderate symptoms of low mood, anhedonia, poor appetite, and poor sleep, despite completing a full course of cognitive behavioural therapy. Her therapist has recommended medication, and the patient is open to this option. What is the appropriate first-line treatment for her depression?
A 60-year-old retiree comes in for his annual diabetes review. He has type II diabetes; the condition seems to be well controlled with metformin, with HbA1c levels in the target range and no signs of end-organ damage.
During the consultation, the nurse asks some routine questions and is alarmed to find that the patient drinks almost 50 units of alcohol a week. The patient insists that he only drinks at the end of the day to relax, and on a Sunday when he goes to the pub with friends. He is adamant that he does not have a drinking problem and that he could stop at any time if he wanted to.
The nurse refers the patient to the doctor to assess for potential signs of alcohol dependency.
Which of the following are indications of alcohol dependency?
A 22-year old woman comes to see her GP, seeking medication for opioid withdrawal. She explains that she has been using heroin for the past six months since losing her job as a store manager. She informs the GP that she has decided to quit using heroin and has not taken any for the past three days. She reports experiencing severe withdrawal symptoms that have been affecting her daily life and asks if there is anything that can be prescribed to alleviate her symptoms.
What are the observable indications of opioid withdrawal?
You speak to the husband of a patient with depression who was recently discharged from a psychiatry ward after a suicide attempt. He was switched from sertraline to venlafaxine. His husband says his mood is okay but over the last 2 weeks, he became erratic and was not sleeping. He spoke fast about a ‘handsome inheritance’ he got but was gambling away their savings saying he was going to save the world. When confronted he became angry and accused him of trying to ‘steal his energy’. You suspect he’s developed mania and refer him to the crisis psychiatry team.
What do you anticipate will be the subsequent step in management?
A 60-year-old patient with a history of bipolar disorder visits your GP clinic for routine blood tests. Despite feeling completely fine, he wants to check his health status. Upon clinical examination, there are no signs of splenomegaly or lymphadenopathy.
The following are the results:
– Hb 140 g/L Male: (135-180) Female: (115 – 160)
– Platelets 160 * 109/L (150 – 400)
– WBC 14 * 109/L (4.0 – 11.0)
– Na+ 144 mmol/L (135 – 145)
– K+ 4.7 mmol/L (3.5 – 5.0)
– Urea 5.4 mmol/L (2.0 – 7.0)
– Creatinine 114 µmol/L (55 – 120)
– Thyroid stimulating hormone (TSH) 5.2 mU/L (0.5-5.5)
– Free thyroxine (T4) 9.5 pmol/L (9.0 – 18)
– Lithium level 0.75 mmol/L (0.6 – 1.2)
What advice would you give to this patient?