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?
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 His grooming is poor and he is socially withdrawn.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?
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?
A 39-year-old male has been taking olanzapine for the last 3 years. After experiencing an episode of tardive dyskinesia, he researched the potential side-effects of the medication. What is the most probable biochemical side-effect that this patient may experience?
A 50-year-old woman arrives at the emergency department complaining of palpitations, dizziness, and lightheadedness. Upon conducting an ECG, torsades de pointes is observed. Which medication is the most probable cause of the cardiac anomaly?
A client under your care has been prescribed imipramine for depression. What combination of side-effects is most probable in an individual taking this type of antidepressant?
A patient with a known history of schizophrenia presents to the Emergency Department with nausea, diarrhoea, coarse tremor and unsteadiness on her feet. She is taking the following prescribed medications: clozapine 150 mg mane and 300 mg nocte, lithium carbonate 200 mg bd and sertraline 50 mg od. Blood results are as follows:
Investigation Result Normal Value
Clozapine level 444 ng/ml 250 to 350 ng/ml
Lithium level 2.3 mmol/l 0.4–1.2 mmol/l
Blood glucose 6.1 mmol/l < 7 mmol/l
White cell count (WCC) 8.0 × 109 4–11 × 109/l
Neutrophils 4.5 × 109 2.5–7.58 × 109/l
What is the most likely diagnosis for a patient in their 30s with these symptoms and medication history?
A 30-year-old woman is in a car accident. Another car collided with a truck and she swerved to avoid them, hitting a tree. Two weeks later, she still experiences flashbacks, nightmares, and difficulty sleeping. Her brother reports that she startles easily and seems disoriented at times. The woman denies any chest pain or dizziness.
What is the probable diagnosis?
A 20-year-old female has presented to the emergency department with a history of diarrhoea for the past week. She denies any blood in her stool or exposure to infectious agents. The patient reports feeling more fatigued and sleeping more than usual.
The patient has a history of depression and was prescribed sertraline. However, she stopped taking the medication two weeks ago as she felt she no longer needed it. Her mental state is currently stable and euthymic.
During the general examination, the patient’s pupils are noted to be bilaterally dilated, which was also observed during her childhood. What is the most likely feature in this patient that is a result of discontinuing her medication?
A 28-year-old man visits his GP with complaints of poor memory. He works in a consulting company and recently faced trouble at work after missing a flight to a client in Tokyo. He has difficulty falling asleep and wakes up feeling exhausted. Sometimes he wakes up in the middle of the night screaming. When awake, he cannot relax and appears to be constantly on edge.
The patient has a history of attention-deficit hyperactivity disorder during childhood and one major depressive episode during his university years. He has not had any mental health-related complaints since then. He drinks one bottle of wine on Saturdays with his wife and admits to occasional past cocaine use. However, he stopped using cocaine after being ambushed and stabbed while dealing with a dealer during his last vacation in Thailand two months ago. His wife has recently complained that he appears emotionally unavailable.
Upon physical examination, no abnormalities are found. However, during the mental state examination, the patient exhibits low mood and an increased startle response. What is the most likely diagnosis?