Archives: Medical Student Finals

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?

MSFinals-5420

A 40-year-old man presents to his General Practitioner with symptoms, including chorea, incoordination, personality changes and psychiatric symptoms such as depression. His father died at the age of 55. You suspect this may be a case of Huntington’s disease.
Which of the following investigations would be the most useful to confirm this diagnosis?

MSFinals-5401

A 27-year-old woman is admitted to the psychiatric ward. She appears lethargic. When asked about her emotions, she responds, ‘Let me start by telling you about my recent job interview. It went well, but I’m still waiting to hear back. I really need this job to pay off my student loans and start saving for a house. I’ve been feeling stressed about money lately.’ She continues to talk about her financial situation.
Upon further questioning, she exhibits similar behavior and speaks slowly throughout.
How would you describe her behavior?

MSFinals-5402

A patient in their 50s is brought to the acute mental health unit by the police after being found on the street shouting at people. They have no known past medical history.

On examination, they are poorly dressed. When asked about their mood, they begin by asking what colour the sky is, then begin to talk about their strong dislike for cheese, followed by wanting to break the table lamp they own at home. Throughout the consultation, they speak slowly.

What term best describes this patient’s presentation?

MSFinals-5399

A 30-year-old woman visits her GP complaining of feeling down. She finds it difficult to work with her colleagues and believes they are not performing up to par. Consequently, she declines to delegate tasks and has become exhausted.
Upon further inquiry, she adheres to a strict daily routine and tries to avoid deviating from it as much as possible. If she fails to follow this plan, she becomes anxious and spends her free time catching up on tasks.
What is the most suitable course of action in managing her probable diagnosis?

MSFinals-5400

A 38-year-old man presents to the Emergency Department complaining of epigastric pain. The patient reports that he developed acute abdominal pain 2 hours prior to presentation after eating a cheeseburger. The patient otherwise has no significant past medical history. He does not take any medications and denies smoking, alcohol consumption and drug use. He has been recently been released from prison and has not got stable living and has had to sleep outside since his release.
On examination, the patient has normal vital signs. His abdominal examination demonstrates normoactive bowel sounds, no tenderness to palpation in the epigastrium and no guarding or rebound tenderness. Rectal exam for stool occult blood is negative and a chest X-ray does not reveal free air under the diaphragm. A right upper quadrant ultrasound does not demonstrate stones. The doctor recommends antacids. When the doctor tells the patient that he is safe for discharge, the patient insists that he must be admitted to hospital for further tests.
Which of the following is the most likely diagnosis?

MSFinals-5382

A 55-year-old man visits his GP clinic complaining of chronic constipation that has persisted for several years. He reveals that he has not had a bowel movement in ten days. The patient has a medical history of atrial fibrillation, type II diabetes mellitus, gastro-oesophageal reflux disease, and paranoid schizophrenia. He is currently taking apixaban, clozapine, digoxin, metformin, and lansoprazole. During the physical examination, the doctor notes a hard, non-tender abdomen and fecal impaction upon PR examination. Which of the medications listed above is likely contributing to his long-standing constipation?

MSFinals-5383

A 56-year-old man presents with a range of physical symptoms that have been ongoing for the past 7 years. Despite multiple investigations and consultations with various specialists, no organic cause has been found for his symptoms. What is the most likely diagnosis for this patient?

MSFinals-5394

A 42-year-old woman presents to her GP with concerns about symptoms that have been affecting her for several years but are now becoming more disruptive to her daily life. She has been experiencing obsessive thoughts about her loved ones being harmed and feels compelled to perform certain rituals to prevent this from happening. She spends hours each day checking and rechecking that appliances are turned off and doors are locked. Her relationships are suffering, and she is struggling to maintain her job. She is hesitant to take medication but is open to exploring other treatment options.
What is the most appropriate psychological approach for managing OCD in this case?

MSFinals-5397

A 28-year-old man presents to his GP with ongoing sleep issues due to tension in his relationship with his girlfriend. He feels she is distant and suspects she is spending time with her ex-boyfriend who works in the same office. Upon further questioning, he reveals a history of feeling uninterested in past relationships and struggles with mood swings. He expresses feeling alone in the world and that even his friends are against him. Although he self-harms, he denies any suicidal thoughts. A referral to psychiatry leads to a diagnosis of borderline personality disorder. What is the most appropriate treatment for this patient?