Archives: Medical Student Finals

MSFinals-5426

You receive a call from the husband of a 50-year-old patient who is registered at your practice. The patient has a history of type 2 diabetes mellitus treated with metformin. According to her husband, for the past three days, she has been talking nonsensically and experiencing hallucinations. An Approved Mental Health Professional is contacted and heads to the patient’s residence. Upon arrival, you encounter a disheveled and emaciated woman sitting on the pavement outside her home, threatening to physically harm you. What is the most appropriate course of action?

MSFinals-5427

You are evaluating a 22-year-old male with depression who has had limited success with various antidepressants and counseling. You opt to initiate a trial of mirtazapine. What side effect of this antidepressant can you advise him is a common feature?

MSFinals-5429

A 21-year-old man is brought to the psychiatrist by his father. He expresses concern for his son’s mental health, as he has noticed him talking to himself frequently over the past 6 months. The patient is hesitant to speak with the psychiatrist and insists that his father stay in the room with him. During the psychiatric evaluation, it is revealed that the patient has been hearing a voice in his head for the past year, but denies any thoughts of self-harm or harm to others. The psychiatrist recommends a referral for further treatment, which causes the father to become emotional and question if he did something wrong as a parent. Which factor from the patient’s history is a poor prognostic indicator for his condition?

MSFinals-5430

A 48-year-old woman with a history of manic-depressive psychosis, diagnosed at the age of 23, presents to her General Practitioner with polydipsia and polyuria. Current medication includes lithium and a steroid inhaler for bronchial asthma. Examination reveals a blood pressure (BP) of 110/75 mmHg, with a pulse of 80 bpm and regular. There are normal fasting sugar levels and there is no postural drop on standing.
What are the investigation findings most likely to help diagnose this condition?

MSFinals-5433

A 28-year-old man is brought to the Emergency Department by ambulance after his partner reported he ingested multiple tablets of paracetamol after an argument. The patient is currently medically stable and can give a history to the attending emergency physician. He reports that he regrets taking the tablets and that this is the first time he has committed such an act. He claims that he acted in a moment of anger after the argument and never planned for this to happen. He suffers from moderate depression which has been managed by his general practitioner with sertraline. He consumes a moderate amount of alcohol and denies any abuse of recreational drugs. He has no family history of mental illness.
Which one of the following is an important dynamic risk factor to consider when managing this patient?

MSFinals-5434

Sarah is a 20-year-old woman who has just started her first year at university. She is described by others as quite a reserved character. She has one friend but prefers solitary activities and has few interests. Sarah has never had a boyfriend and does not seem to be interested in companionship. When she is praised or criticised by others, she remains indifferent to their comments. There is no history of low mood or hallucinations.

What is the most probable diagnosis for Sarah’s condition?

MSFinals-5435

A 25-year-old man arrives at the emergency department following his fifth suicide attempt in the past two years. He was discovered by his ex-girlfriend, who ended their relationship the day before due to his intense mood swings and overwhelmingly negative emotions. He has no communication with his family and appears unkempt. When questioned, he expresses feelings of worthlessness and a belief that everyone will eventually leave him. What is the probable diagnosis?

MSFinals-5436

A 76-year-old man visits his doctor with his wife, who is concerned about his recent memory decline and difficulty concentrating. She also notes that he has become incontinent of urine and is walking with smaller steps. The patient’s medical history includes a myocardial infarction one year ago, as well as hypertension and diabetes. There is no family history of similar symptoms. What is the probable diagnosis?

MSFinals-5437

A 45-year-old man with a history of schizophrenia no longer reports hallucinations or delusions. However, he spends many hours doing nothing, has trouble reading a book or watching a film and rarely speaks spontaneously or fluently. His grooming is poor and he is socially withdrawn.
What is a positron emission tomography (PET) scan most likely to show?

MSFinals-5438

Sarah, a 15-year-old girl is brought to the GP by her father as Sarah has not had her first period. She is 1.50m tall and weighs 40 Kg. Her heart rate is 60 beats per minute. Blood pressure is 120/90 mmHg. She has not developed any secondary sexual characteristics. There is a strong family history of eating disorder. You suspect that the delayed puberty may be due to anorexia nervosa.
What evidence supports the diagnosis of anorexia nervosa in Sarah?