A 35-year-old homeless man is brought to the hospital as he reports seeing an ‘ocean of bees’ surrounding him. He is unable to provide a detailed medical history due to his extreme anxiety and confusion, constantly yelling about the ‘deafening buzzing.’ His heart rate is 140 beats per minute and his breathing rate is 23 breaths per minute. Reviewing his records, it is noted that he has been admitted to the emergency department multiple times due to alcohol intoxication.
What is the initial treatment for his condition?
MSFinals-5410
A 32-year-old with a long standing history of schizophrenia presents to the emergency department in status epilepticus. After receiving treatment, he informs the physician that he has been experiencing frequent seizures lately. Which medication is the most probable cause of his seizures?
MSFinals-5411
A 35-year-old female comes to your clinic with concerns that her husband is cheating on her. They have been married for 10 years and have always been faithful to each other. She is a stay-at-home mom and her husband works long hours. You wonder about the likelihood of her claims being true.
What is the medical term for this type of delusional jealousy?
MSFinals-5412
A 95-year-old man without past medical history presents with increasing forgetfulness. His son is concerned that over the last six weeks his father has been forgetting his grandchildren’s names and stories from his upbringing. The patient reports a loss of appetite, sometimes forgetting if he has eaten, is not getting good quality sleep and is frustrated with his son for taking him to the doctors. He sometimes sees and hears his recently deceased wife. Based on these symptoms, what is the most probable diagnosis for this patient?
MSFinals-5413
A 28-year-old man visits his General Practitioner on the advice of the Community Psychiatric Nurse. He has been experiencing a fever and sore throat lately. He is currently on clozapine for treatment-resistant schizophrenia. What would be the most crucial investigation to conduct, considering his recent symptoms?
MSFinals-5414
You are considering prescribing an antidepressant to a 75-year-old woman who has been experiencing low mood and difficulty maintaining her weight due to low appetite. Which psychiatric medication could potentially improve both her mood and appetite?
MSFinals-5415
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?
MSFinals-5416
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?
MSFinals-5418
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?
MSFinals-5419
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?