Archives: Medical Student Finals

MSFinals-5336

You are working in a GP surgery and your next patient is John, a 35-year-old man with a diagnosis of generalised anxiety disorder (GAD). He is currently prescribed sertraline 200mg daily.

During the review of his symptoms today, John reports that he does not feel like the sertraline is helping, and he remains anxious almost all of the time. He experiences frequent episodes where he feels his heart pounding in his chest and his head is spinning. Additionally, he notes that he often struggles to get to sleep and can lie awake for hours at night.

As you observe John, he appears visibly distressed. He seems unable to sit still in his chair and is trembling slightly.

What would be the next step in John’s management?

MSFinals-5337

A 47-year-old male comes to the GP with concerns about his difficulty falling asleep. He believes that he may be suffering from chronic insomnia, which he has read about online.

The patient reports that he has attempted various methods to help him sleep, such as meditation and taking a warm bath before bed. However, he feels that he has too many thoughts racing through his mind and cannot seem to turn them off. This occurs at least three times a week and has persisted for the past month.

What indication would suggest that this individual has misdiagnosed himself?

MSFinals-5338

A 42-year-old female with a lengthy history of schizophrenia has been admitted to a psychiatric inpatient facility due to a worsening of her psychosis caused by non-adherence to medication. During an interview with the patient, the psychiatrist observes that while the patient’s speech is mostly comprehensible, she occasionally employs words like flibbertigibbet and snollygoster that appear to hold significance only for the patient.

What is the most appropriate term to describe the patient’s speech abnormality?

MSFinals-5339

You are on a pediatric liaison rotation, and have been asked to talk to a 6-year-old patient with known ADHD. Upon trying to take a history from him, you struggle to follow his train of thought, as he keeps saying things like: ‘I like pizza, it’s so cheesy and easy — my dog is brown, he likes to run around — I have a blue pencil, it’s my favorite utensil -‘. You suspect that his thought process is characterized by rapid shifts from one idea to another without any apparent connection.
What is the medical term for this psychiatric symptom?

MSFinals-5340

A 30-year-old male is brought to the emergency department by his friends as they are concerned that he is talking and behaving oddly.

When asked about the health of his parents he responded that Yesterday I went to visit my father. He was on the roof cleaning the gutters. This seems like a dangerous activity, as there is a high risk of falling and causing an injury. Still, we are all at risk of injuries a lot of the time, for example when driving our cars. We could also cause injuries to ourselves simply by tripping and falling. I think you are at greater risk of falling if your house is poorly lit, you have trip hazards such as loose cables and if your reflexes or depth perception are impaired, for example, when you are intoxicated. When I saw my father yesterday he seemed well and he has no current medical conditions.

What is the best term to describe the abnormality of speech that the patient is demonstrating?

MSFinals-5341

A 50-year-old man is brought to the emergency department by the authorities after causing a disturbance in public. He is visibly anxious and upset, insisting that there are bugs crawling under his skin and that your face is melting. Upon reviewing his medical history, it is evident that he has a history of alcohol abuse and has been in contact with Drug and Alcohol Services. What scoring system would be best suited for assessing this patient once he is stabilized?

MSFinals-5342

A 29-year-old man with general anxiety disorder (GAD) visits his GP for a review of his medication. He was prescribed sertraline during his last appointment, but he reports that he still experiences physical and psychological symptoms of anxiety on most days. Although there has been no recent deterioration in his condition, he feels that the medication has not been effective. What alternative medication should be considered?

MSFinals-5343

A 26-year-old man comes for his scheduled psychiatry visit after being prescribed Risperidone for his recent diagnosis of schizophrenia. Although he has been stable since starting this medication, he reports experiencing milky discharge from both nipples and inquires about alternative medications that can manage his schizophrenia without causing this side effect. What would be the most suitable medication to consider as an alternative?

MSFinals-5344

A 17-year-old boy visits his doctor complaining of low mood. He has been experiencing this for the past 5 weeks along with fatigue, anhedonia, and oversleeping. The doctor orders a set of blood tests and his PHQ-9 score indicates moderate depression. The patient has no medical history. He is not interested in cognitive behavioural therapy and wants to begin medication. What is the best medication for him to start with?

MSFinals-5345

A 42-year-old man is brought to the Emergency Department by his friends. He holds a senior trading job in an investment bank and has a history of recurrent admissions following cocaine intoxication. They are worried because he recently sent a memo to everyone on the trading floor suggesting that he is now the lead, he has the mental capacity to beat anyone to a higher profit and he should be chairman of the group. In fact, he has been performing poorly and has missed recent performance targets.
Which of the following is the most likely diagnosis?