Archives: Medical Student Finals

MSFinals-5386

A 42-year-old man presents to his GP with a sense of sadness and emptiness. He lost his job 8 months ago and has been struggling to focus on his daily activities ever since. ‘I’m just not the same person I used to be,’ he tells the doctor. He has no interest in finding a new job and spends most of his time at home. He denies any thoughts of suicide. His sleep is disturbed and he wakes up feeling tired. He also reports a decreased interest in sex with his partner. His medical history is significant only for a bilateral hand tremor that worsens with movement. He is a non-smoker and only drinks socially. What is the most likely diagnosis?

MSFinals-5387

A middle-aged man presents with persecutory delusions and auditory hallucinations. His expression appears to have a reduced affect. He has disorganised speech and thinking.
What is the most probable diagnosis for this patient?

MSFinals-5388

A mother brings her 8-year-old son to see the general practitioner (GP) as she is very concerned about his school performance. His teacher has reported that he is being highly disruptive in the classroom.
Which of the following sets of behaviours fit best with a diagnosis of attention deficit/hyperactivity disorder (ADHD)?

MSFinals-5389

A 28-year-old male with bipolar disorder is currently under the care of his psychiatrist as an outpatient. During the review, the psychiatrist observes that the patient’s speech mostly follows a logical sequence, but at times, the patient uses a seemingly inappropriate series of rhyming words. For instance, when asked about his activities the previous day, he responded, I went for a run, had some fun, saw the sun, and then I was done.

What is the most appropriate term to describe the speech abnormality exhibited by the patient?

MSFinals-5390

A 26-year-old male comes to his doctor’s office at the request of his friends. Upon examination, he discloses that he thinks everyone can hear his thoughts, as if he were a radio station, and that he hears voices commenting on his actions. The doctor observes that he has a blunted affect, alogia, and avolition. Additionally, the doctor notes that the patient repeats the final word of any inquiry posed to him.

What term describes this phenomenon?

MSFinals-5391

You’re on an acute take ward and you are asked to see a patient by your foundation doctor. The foundation doctor is concerned about this patient as he is uncertain of the next step in management and investigation.
The patient is a 46-year-old male who has been admitted with excess tearing. He has a past medical history of allergic rhinitis. He uses nasal saline rinses several times a day. His father recently died of lung cancer with brain metastases.
This patient has had extensive investigations in multiple other hospitals due to his concerns of a cancer diagnosis causing his excessively watery eyes. He has had three CT orbits in the last 12 months which have been reported as normal. On ophthalmic examination, he has some crusting and erythema of his lid margins, but it is a normal examination otherwise. The patient remains convinced that a cancer diagnosis still can’t be excluded.
What is the reason for this patient’s presentation?

MSFinals-5392

A 20-year-old woman presents to her General Practitioner (GP) with a 2-year history of restricting food intake and self-induced vomiting. She attends her GP for the first time with her sibling reporting a recent worsening of her symptoms. The GP suspects anorexia nervosa.
Which is the most appropriate investigation to determine whether the patient requires urgent hospital admission?

MSFinals-5393

A 32-year-old female presents to her primary care physician with her sister. The sister is worried that the patient may have a personality disorder due to her lack of interest in socializing and her preference for being alone. Upon further discussion, the patient admits to having no desire for romantic relationships, being unemployed, and lacking motivation to work. She denies any self-harm or suicidal thoughts and has no history of legal issues. During the consultation, she displays a flat and emotionless facial expression. What personality disorder is most likely present in this patient?

MSFinals-5396

A 28-year-old woman experiences chest pain following an argument with her 16-year-old daughter. She is brought to your clinic for evaluation. Upon examination, she appears anxious and is hyperventilating. She exhibits tenderness to light pressure on the front of her chest, but her oxygen saturation is 99% while breathing room air. An ECG reveals no abnormalities. What is the most suitable course of action for this patient?

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?