Archives: Medical Student Finals

MSFinals-5303

A 25-year-old man presents to the Emergency Department in a distressed state. He says he hears voices telling him that he is worthless and that the people talking to him know what he is doing as they are listening to his thoughts via the television and radio. His friends who attend with him tell you that he has become withdrawn over the past few months and has been missing lectures. There is a history of cannabis use but nil else of note. When he talks to you, he appears to have constructed a number of new words to describe the machines used to listen to him.
Investigations:
Investigation Result Normal value
Haemoglobin 139 g/l 135–175 g/l
White cell count (WCC) 6.1 × 109/l 4–11 × 109/l
Platelets 294 × 109/l 150–400 × 109/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l
Potassium (K+) 4.3 mmol/l 3.5–5.0 mmol/l
Creatinine 100 μmol/l 50–120 µmol/l
Alanine aminotransferase (ALT) 34 IU/l 5–30 IU/l
Bilirubin 16 μmol/l 2–17 µmol/l
Which of the following is the most likely diagnosis?

MSFinals-5304

An 18-year-old boy takes an overdose of 12 paracetamol tablets after a fight with his best friend. He is found by his roommate and rushed to the hospital.

What is the most significant factor that suggests a high likelihood of a successful suicide attempt?

MSFinals-5305

A 22-year-old university student has been advised to see her General Practitioner by teaching staff who are very concerned that she has lost a lot of weight throughout the term. She has lost 10 kg over the last six weeks but does not see any problem with this.
Which of the following is a diagnostic criterion for anorexia nervosa (according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V))?

MSFinals-5308

A 25-year-old man is receiving electroconvulsive therapy (ECT) for his treatment-resistant depression. What is the most probable side effect he may encounter?

MSFinals-5309

As an F2 in psychiatry, you come across the notes of a 27-year-old man who is noted to prefer solitude, has never been in a romantic relationship, and has no desire for one. He also displays minimal interest in engaging in sexual activities with others. Despite performing well at work, he places little importance on feedback from his colleagues. Based on this information, which personality disorder is most likely present in this individual?

MSFinals-5310

A 35-year-old man presents to a psychiatrist after his wife demands he sees someone to manage his ‘endless nagging’. He has no interest in being here. He reports that his wife is always frustrating him because she simply will not do things the right way. He cites frequent eruptions over how to load the dishwasher properly and how his wife continues to load it improperly. When asked what happens if she loads it her way, the patient describes feeling frustrated that it is not loaded the right way and expressing his frustration to his wife. When asked what he hopes to get out of this visit, the patient wants to learn if there are better ways of effectively communicating the right way to do things.

Which of the following is most likely?

MSFinals-5311

A 25-year-old basketball player undergoes an anterior cruciate ligament repair following an injury. He is advised by his medical team that he will need an extended period of rest and physiotherapy before he resumes competitive basketball. Following the surgery, he says he feels better and discharges himself. He later goes out with his friends and tells them that he will be back on the court next week.

What type of coping is this?

MSFinals-5312

A father is concerned about his 19 year-old daughter, who has recently become more reclusive and spends most days in her bedroom. She has stopped socialising with friends and has dropped out of college. She has also removed all the mirrors in her room as she believes that people are spying on her through the mirrors. The father’s sister has had schizophrenia in the past, and he is worried that his daughter is showing very similar symptoms.
Which of the following statements best characterises the aetiology of schizophrenia?

MSFinals-5313

A 22-year-old female with paranoid schizophrenia is currently admitted as an inpatient and receiving treatment with antipsychotic medication under section 3 of the Mental Health Act. She has recently reported experiencing breast tenderness and enlargement. As the current antipsychotic regimen is not being well-tolerated, what would be the most suitable alternative antipsychotic medication to minimize these side effects?

MSFinals-5314

A 32-year-old woman presents to her GP for her 6-week postnatal check-up. She mentions feeling mildly depressed at times but denies any issues with her eating or sleeping habits. She is managing well with taking care of her baby and has a strong support system from her loved ones. She is currently breastfeeding.
What would be the most suitable course of action for her management?