Archives: Medical Student Finals

MSFinals-5498

A 22-year-old man with a history of hearing voices is brought to the Emergency Department by his family. He describes these voices as telling him to kill himself, ‘as he has a demon in him’. He also reports noting his intelligence being tapped through the television by a higher power. This has been going on for the past 3 months. His family denies either depression or manic episodes. The patient was admitted to the inpatient Psychiatry Unit and, after an evaluation, a diagnosis of schizophreniform disorder was made. He was started on Haldol (haloperidol) for his symptoms. Two days after initiation of therapy, the patient’s temperature rose to 41 °C, blood pressure 150/85 mmHg and pulse 110 bpm. Physical examination revealed muscular rigidity and delirium.
What is the most likely diagnosis?

MSFinals-5499

A 50-year-old man visits his GP in a state of distress. He recently returned from a vacation and forgot to renew his prescriptions, resulting in him not taking his medications for the past week. The patient is currently experiencing general discomfort, nausea, and excessive diarrhea. Upon conducting a thorough examination and reviewing his medical history, the GP suspects that his symptoms are due to the discontinuation of one of his medications. The patient has a medical history of depression, gout, hypothyroidism, and type two diabetes mellitus. He also occasionally uses zopiclone to treat his insomnia. Which medication withdrawal is likely causing the patient’s symptoms?

MSFinals-5500

A 70-year-old man comes in for his routine psychiatric follow-up appointment. He has a history of schizophrenia that has been difficult to manage, but has been stable for the past 5 years on various antipsychotic medications. He also has type II diabetes. During the appointment, he reports experiencing repetitive, involuntary movements of his lips and tongue, including lip smacking and grimacing. Which medication is the most likely culprit for these symptoms?

MSFinals-5476

A 56-year-old man is brought to the emergency department by ambulance, after being found confused by members of the public for the fifth time in the past month. Upon review, he tells you that he came here by bicycle after spending the afternoon with his friends doing shopping, and then later tells you he spent today in the pub with his new dog. He smells strongly of alcohol and you notice a near-empty bottle of unlabelled spirit with him.
On examination, he has an ataxic gait, dysdiadochokinesia and horizontal nystagmus.
When you go back later to see him, he has forgotten your previous interaction.
Which of the following explains his signs and symptoms?

MSFinals-5477

A 50-year-old male with schizophrenia is being evaluated by his psychiatrist. During the consultation, the psychiatrist observes that the patient appears disinterested and unresponsive when discussing recent and upcoming events in his life, such as his upcoming trip to Hawaii and his recent separation from his spouse.

What is the most appropriate term to describe the abnormality exhibited by the patient?

MSFinals-5483

A 30-year-old man without known psychiatric history is admitted to the psychiatry ward, after presenting to the emergency department with delusions and homicidal ideations.

Following a negative drugs screen, antipsychotic treatment is initiated with haloperidol.

The patient is reviewed 3-hours after the initiation of treatment and is noted to have a sustained upward deviation of both eyes. When asked, he reports that his eyes are extremely painful.

What is the most appropriate initial management option based on the likely diagnosis?

MSFinals-5488

A 28-year-old man with a history of moderate depression presents to his GP after being prescribed a new medication by his psychiatrist. He reports experiencing a significant increase in appetite and subsequent weight gain, as well as constant fatigue and difficulty concentrating at work.
What medication is most likely responsible for these symptoms?

MSFinals-5489

A very thin 20-year-old woman is referred for evaluation of weight loss. Anorexia nervosa is suspected, but various screening tests are conducted to confirm the diagnosis. Which of the following findings would support the diagnosis of anorexia nervosa?

MSFinals-5490

A 23-year-old woman is scheduled for a routine phone consultation. Her father is worried about her well-being, but she insists that she is fine and has no issues. Her father believes that she is socially withdrawn as she does not have any friends and spends most of her time indoors using her phone. Upon further inquiry, you discover that this woman has a strong belief that her phone is being monitored by the government, which is contributing to her isolation. She does not exhibit any psychotic symptoms, and her speech, tone, and mood are all normal. What is the most probable diagnosis?

MSFinals-5491

A 35-year-old man is brought to his GP by his partner who is concerned he may have developed bipolar disorder over the last few months.
The man experiences periods of elevated mood, where he spends a lot of money and sleeps very little. He denies having any delusions of grandeur. These episodes usually last for a few days, and he has never put himself or others in danger.
The man also has episodes of severe depression, where he feels suicidal, loses interest in his hobbies, and sleeps excessively. He is referred to a psychiatrist for further evaluation.
What is the most probable diagnosis?