Archives: Medical Student Finals

MSFinals-5551

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?

MSFinals-5552

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?

MSFinals-5553

A 27-year-old woman presents with a 3-day history of inability to use her right arm. She has been staying with her mother for the past 5 days after experiencing domestic abuse from her husband. The patient reports feeling very stressed. She denies any history of trauma. On examination, there is normal tone and reflexes but 0/5 power in all muscle groups of the right upper limb. The affected arm falls to the patient’s side when held above her face and released. What is the probable diagnosis?

MSFinals-5554

A 21-year-old woman is brought to her General Practitioner for follow-up 1 week after being attacked and raped by an acquaintance on her university campus. Immediately after the episode, she was seen in the Emergency Department for her injuries and evidence gathering, interviewed by the police and discharged home. Today she reports difficulty sleeping and flashbacks about the event. She has had difficulty concentrating at university and feels anxious that ‘something bad’ might happen to her again.
Which one of the following is the most likely diagnosis?

MSFinals-5555

As you explore non-pharmacological treatments for different mental health conditions during your psychiatry rotation, you come across electroconvulsive therapy (ECT). Which of the following mental health conditions can be treated and managed using ECT?

MSFinals-5556

A 36-year-old woman comes to her General Practitioner (GP) complaining of mood changes eight days after giving birth. She expresses that she does not want the baby and believes that it is dying. She feels like crying constantly. She experiences auditory and visual hallucinations that tell her to harm herself. Apart from this, she has no significant medical history.
What is the diagnosis for this patient?

MSFinals-5557

A 56-year-old man without medical history is beginning treatment with tranylcypromine for his depression. What foods should he be cautioned against consuming?

MSFinals-5558

Sophie is a 25-year-old woman who was diagnosed with generalised anxiety disorder 8 months ago. She has been taking sertraline for 5 months but feels that her symptoms have not improved much. Sophie wants to switch to a different medication. What is the most suitable drug to start?

MSFinals-5559

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?

MSFinals-5560

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?