Archives: Medical Student Finals

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-5484

A 25-year-old woman returns to your clinic complaining of constant feelings of sadness, loss of appetite, insomnia, and a lack of enjoyment in anything. Despite making lifestyle changes and setting small goals, she still feels hopeless and requests medication. You decide to prescribe sertraline. What drug should be avoided in patients taking an SSRI?

MSFinals-5485

A 67-year-old man presents to the hospital in a confused state. He is unable to explain his condition but insists that he was admitted for 10 days last month despite records showing his last admission to be 7 months ago. He cannot recall which secondary school he attended and, after being on the ward for a week, he does not recognize his primary doctor’s face. The patient has a medical history of hypertension, ischemic stroke, and alcoholic liver disease.

Upon examination, the patient has normal tone, upgoing plantar reflexes on the right, and a broad-based gait. There are bilateral cranial nerve 6 (CN 6) palsies associated with nystagmus.

What is the probable diagnosis for this patient?

MSFinals-5486

Samantha, a 35-year-old woman, arrives at the emergency department complaining of severe, sharp pain on her left side that radiates to her lower abdomen and groin. The pain comes and goes in waves and has been ongoing for 10 hours. She also reports an increased frequency of urination and a burning sensation while urinating. A urine dip reveals haematuria but no signs of infection. You request the following blood tests:
Calcium 3.3 mmol/L (2.1-2.6)
Corrected Calcium 3.4 mmol/L (2.1-2.6)
Phosphate 0.6 mmol/L (0.8-1.4)
Magnesium 0.8 mmol/L (0.7-1.0)
Thyroid stimulating hormone (TSH) 4.9 mU/L (0.5-5.5)
Free thyroxine (T4) 9.5 pmol/L (9.0 – 18)
Parathyroid hormone 85 pg/mL (10-65 )
Which medication’s long-term use is responsible for Samantha’s condition?

MSFinals-5487

A 32-year-old man comes to you seeking help as he feels like he is not himself lately. He has been struggling since his divorce 8 months ago. For the past 5 weeks, he has been experiencing low moods for most of the day, particularly in the mornings when he wakes up early. He has lost interest in his usual hobbies, including going to the gym. He has not been to any of his regular workout classes. He has had thoughts of taking a bottle of pills to end it all, but he knows he won’t do it because he has a supportive family. He has no significant medical or psychiatric history.

Which of the following treatments would be the most appropriate?

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?

MSFinals-5492

A 50-year-old man has been admitted to a psychiatric ward for a fourth time. He is withdrawn, irritable, restless and afraid. He says that he has been depressed for about 8 weeks. He has insomnia, loss of appetite and weight loss. He also has suicidal ideation with a plan to overdose on medicine, which he has done in the past under the influence of commanding auditory hallucinations. He hears voices often even when he is not depressed, but they only talk of suicide when he is depressed. He was divorced 5 years ago and has trouble holding jobs due to his paranoia and odd behaviour.
What is the most likely diagnosis?