Psychiatry 🧠💊

A 22 year man finds it difficult to come out of a room without having to turn the light switch off and on 3 times. He has tried more than several times to go out of the room without having to do this particular compulsion however he still returns to the room feeling agitated that it was not done. He recognizes that he has a problem and is willing to see a psychiatrist. What is the SINGLE most accurate term that describes this situation?

A 60 year old man was brought to A&E by his daughter following ingestion of a large amount of medications. His daughter says that he has been withdrawn lately and that he has been neglecting himself. The patient himself says that he is tired of life and mentions that he has not left his house in the past three weeks as he claims that his neighbours are talking about him. He also claims that his neighbours have evil thoughts toward him. The patient concedes that he needs help. What is the SINGLE most appropriate next step in management of this patient?

A 29 year old woman presents to the GP surgery requesting a fit note as she feels she would need the next few days off from work due to anxiety. She has not gone to work for the past 7 days as she has been feeling anxious. She works as a financial advisor in a large company. She suffers from panic attacks and has been experiencing several episodes over the past week. She took leave for a period of 6 weeks last year for similar issues. She feels that her job can be very stressful. What is the SINGLE most appropriate action?

A 35 year old schizophrenic man hears voices narrating his actions like “he is going to the toilet” and “he is leaving the house”. What is the SINGLE most likely type of

hallucinations involved?

A 22 year old woman comes to the clinic with obsessive ideation that she is overweight. Her body mass index is 17 kg/m2. She is on a strict diet and does aerobic exercises 3 times a day. While taking a history, she admits to laxative abuse. On examination, she has patches of thickened calluses on the dorsal aspect of the first interphalangeal joint. Her heart rate is 65 beats/minute and she has a blood pressure of 90/60 mmHg. What is the SINGLE most appropriate action?

A 62 year old man who was admitted for surgery 3 days ago suddenly becomes confused. His attention span is reduced. He is restless and physically aggressive and picks at his bed sheets. What SINGLE aspect of the patient’s history recovered in his notes is most likely to aid in making the diagnosis?

A 28 year old schizophrenic female has been referred to you for medical treatment for the first time. She is not taking any regular medications and is not known to be allergic to any medication. Which is the SINGLE most appropriate antipsychotic medication to be prescribed?

A 38 year old man is visited by his GP as he feels too unwell to leave his house. He has a three-day history of fever and a worsening cough. He has been hearing voices at home lately although no one else is at home. During the consultation, he informs the GP that he has been extremely annoyed with his neighbours lately for playing loud music during the middle of the night. He has told them to keep it down but they have not listened and denied playing loud music. Out of anger and frustration, he has made plans to set his neighbours’ house on fire. His ex-wife who visited him a few days ago is also worried about his recent behaviour. What is the SINGLE most appropriate action?

A 24 year old man attends the Emergency Department desperately seeking imaging of inside his head. He says a microchip was inserted in his brain 3 weeks ago, triggering voices in his head. He believes that his neighbours are determined to attack him, and they have put their voices in his head to disrupt his life. He can hear them narrating his activities, such as “Now, he is going to the hospital to ask for a CT scan”. He feels that his actions are under external influence. He drinks, on average, 25 units of alcohol a week. His last drink was a few hours ago. He denies taking recreational drugs. What is the SINGLE most likely diagnosis?

A 24 year old male on remand in prison for murder is referred by the prison doctor. He is noted to be behaving oddly in prison and complains of hallucinating. He has a previous history of IV drug abuse. On questioning, he provides repeated wrong answers to questions nonetheless, his answers are in the correct category. An example, when asked who is the prime minister of England, he answers Bill Clinton. What is the SINGLE most likely diagnosis?

A 50 year old man presents to his GP surgery for the first time with low moods for the past two months. He quit his job a month ago because he has lost interest and is often fatigued. He has very little appetite and has lost weight. He is very worried about the possibility of bankruptcy due to the absence of a regular income. He does not experience any delusions or hallucinations and has no suicidal thoughts. He is otherwise well and has no cardiac abnormalities. What is the SINGLE most appropriate treatment to offer?

A 29 year old man with a history of depression has been having low moods for the past eight years. He feels hopeless since the birth of his new baby 5 months ago. He has always felt a degree of hopelessness and does not leave the house because he feels worthless. He has anxiety and has palpitations when he leaves the house and goes into open spaces. He was let go from his job as a cleaner 6 months ago and struggles to find a job. He has had 3 attempts to end his life in the past. 2 of them were from painkiller overdoses and 1 of them was from jumping down a bridge into the sea. He drinks 24 units of alcohol a week on average. Which of the following piece of information from his history is a protective factor for another suicide attempt?

A 26 year old woman is afraid to visit the shopping centre. Crowds and public places cause her to panic. She even feels distressed, short of breath and develops palpitations when she boards the train to travel to see her aunt. She feels more relaxed when she goes out to public places with her husband than when alone. Her anxiety has been worsening over the past few months and she now refuses to go out because of this irrational fear. What is the SINGLE most likely diagnosis?

A 16 year old girl with a 3 year history of depression treated with fluoxetine presents to the Emergency Department with acute confusion, agitation, shivering and sweating. She has intermittent jerking and twitching of her arms. Around 5 hours ago, she ingested 30 tablets of fluoxetine after having an argument with her boyfriend. An ECG shows sinus tachycardia at the rate of 140 beats/minute. She has a temperature of 39°C. Her pupils are dilated but reactive to light. What is the most likely diagnosis?

A 35 year old man is seen by his psychiatrist for severe depression. He says that the world has ended and is no longer real. He thinks that he no longer exist in this world. He barely has eye contact with the psychiatrist. What is the SINGLE most appropriate diagnosis?

A 42 year old man with a history of bipolar disorder is noted to have high serum levels of lithium and profound hypokalaemia on routine examination. He was recently diagnosed with essential hypertension and his GP had started him on an antihypertensive medication. What is the SINGLE most likely cause of the recent findings?

A 15 year old girl attends the GP with her mother. Her mother is concerned with her eating habits and weight loss. She is determined to lose weight and exercises excessively. Her mother reports that she induces vomiting after her meals secretly in the toilet. She feels fatigued most of the time and has little interest in social events. She reports that she has not had a menstrual period for the past 3 months. On examination, she has a heart rate of 60 beats/minute, her abdomen is soft and non-tender with no masses or organomegaly. There is no palpable lymphadenopathy. She has a body mass index of 14.8 kg/m2. What is the SINGLE most likely diagnosis?

A 29 year old male presents to Accident & Emergency with the complaint of neck stiffness. The patient’s past medical history is significant for schizophrenia, diagnosed a few months ago. His notes mention that his psychiatrist had just started him on a new drug, clozapine, due to his previous medication not working. He is on no other medication and denies the use of over the counter medications or illicit drugs. He smokes around five cigarettes a day but does not drink alcohol. Upon physical examination, the patient appears to be working hard to breathe. Active and passive flexion and extension of his neck are extremely difficult to achieve. The patient’s face also appears red and flushed. He also appears to be confused. His vital signs are as follows:

Blood pressure 168/98 mmHg

Heart rate of 114 beats per minute Temperature 39.2° C

Oxygen saturation on room air 95%

What is the SINGLE most likely diagnosis?

A 26 year old man with a history of depression has been having low moods for the past five years. He feels hopeless since the birth of his new baby 3 months ago. He has always felt a degree of hopelessness and does not leave the house because he feels worthless. He has anxiety and has palpitations when he leaves the house and goes into open spaces. He does not work because of his low moods. He has had 4 attempts to end his life in the past. 2 of them were from painkiller overdoses and 2 of them were from cutting his wrist. He drinks 20 units of alcohol a week. Which of the following piece of information from his history is most likely to lead to another suicide attempt?

A 33 year old man with a history of depression has been having low mood for the pat Grant Heat that he’d of his job and his life. He works at a manager of a part which he fool can be that that divorced his wife 2 years ago and live alone. He has a childhood history of asthma. He has not been for the last 20 years. Which of the following piece of information from his history is most likely to lead to suicide attempt?

A 44 year old man is very depressed and miserable after his wife’s death 6 months ago. He sees no point in living now that his wife is not around. He feels regret and wishes he never existed. He refuses any medical help offered. His son has brought him to the emergency department. The son mentions that he can not deal with the father’s depression any longer as he has a job and family that to attend to. What is the SINGLE most appropriate next step?

A 55 year old man has a firm belief that the headlines in the newspapers are written especially for him. He believes that the authors of the newspaper articles who he has never met are sending secret and significant messages that only he can understand. What is the SINGLE most likely type of delusion that this man is suffering from?

A 33 year old man with a family history of panic disorder has palpitations, tremors, sweating and muscles tightness on 3 occasions in the last 6 weeks. His pulse rate is 85 beats/minute and his blood pressure is 120/80 mmHg. What is the SINGLE most appropriate long-term treatment for him?

A 33 year old man with a history of severe depression says his insides are rotting and nobody has bothered to bury him. He feels the world no longer exist and nothing matters. His gaze is always downwards and has barely any eye contact with anyone. What SINGLE best term describes his condition?

A 44 year old man had a hernia repair a week ago but returns to the hospital as he is still in significant pain. He is extremely upset that he consented for the surgery a week ago and was unaware that the surgery would result in so much discomfort. He shouts and shows displeasure at the A&E doctors and the surgeons who performed the operation. He angrily states that the operation was not warranted, spits on the surgeon and leaves the hospital. 2 weeks after his encounter in the hospital, he accidentally meets the surgeon on the street. The patient proceeds to apologise and show gratitude towards the surgeon as he feels much better. He now believes the surgery was the correct decision. What is the SINGLE most likely reason for his actions?

A 33 year old woman has been feeling low and having difficulty concentrating since her husband passed away 6 weeks ago. She has been crying almost every day and feeling hopeless. She has been withdrawing from other people and does not want to go out for dinner with her mother. She works as an air hostess and has not gone back to work since the passing of her husband. She refuses to see her friends and would rather stay in bed most of the day. What is the SINGLE most likely diagnosis?

A 12 year old girl with attention deficit hyperactivity disorder has difficulty falling asleep. She is unable to settle down at night. She usually goes to sleep at around 2 am. She feels tired in school and has difficulty concentrating as a result of poor sleep. Occasionally, she misses school because she cannot wake up in time. Her mother has brought her to the GP surgery as she is finding it very difficult to have a good night’s sleep because of her active teenage daughter which results in her having difficulty concentrating at work. What is the SINGLE most appropriate management for the child?

A 64 year old man believes a female newscaster on the television is communicating directly to him when she turns a page and when she looks at the camera. What is the SINGLE most likely type of delusion that this man is suffering from?

A 45 year old man is brought to the Emergency Department by his wife after having cut his own wrist with a kitchen knife while at home alone. He was feeling very low for the past few months since he lost his job as an investment banker. He has not been sleeping well and eating less. He started thinking of taking his own life as he feels he is unable to cope with the stressors of life. He drinks around 30 units of alcohol a week. He does not use recreational drugs. He has no children. He was not under the influence of alcohol when he slit his wrist earlier in the day. His intention for cutting his wrist was to end his life. He does not regret his actions. His wounds have been sutured by the A&E staff. What is the SINGLE most appropriate next step in action?

A 22 year old woman who delivered vaginally 5 days ago is seen by the community midwife. She has been having low moods, crying excessively for no apparent reason and feeling very emotional. She started having these emotions 3 days ago. This is her first child and she fears she would do something wrong as a new mother. She doubts her ability to care for her new baby. She often wakes up at night and looks to see if her baby is still breathing. The baby was delivered at term and is breastfed. There were no complications during pregnancy or delivery. She has a supportive husband. She has no history of mental health disorders in the past. What is the SINGLE most likely diagnosis?

A 24 year old depressed man has neglected his personal hygiene and physical health. He denies the existence of his bowels and believes that his bowels are blocked. He also believes that his limbs are missing and that no one cares about it. What SINGLE kind of delusion is he suffering from?

A 26 year old political refugee has sought asylum in the UK. He complains of poor concentration. He keeps getting thoughts of his family whom he saw was killed in a political coup. He is unable to sleep well and feels hopeless. In the past month, he has had 3 brief episodes lasting a few minutes of feeling detached from his surroundings, as if he was watching the world through misty glass. He is worried that he is going mad. What is the SINGLE most likely diagnosis?

A 22 year old woman is brought to the local hospital by her mother with the primary complaint of recurrent depressive episodes. Her main symptoms during her depressive episodes are low mood, anhedonia, excessive somnolence, and weight loss secondary to poor appetite. Recently however, she has become overly happy and rarely sleeps. Her mother complains that she has maxed out all her credit cards and that she stays out all night drinking and partying. Some nights, she doesn’t even come home. She has had multiple sexual partners during the past week and her mother expresses a concern about contraception. The patient was also recently involved in an altercation with the police. Her grandmother passed away two days ago and the mother tearfully describes her daughter laughing loudly during her grandmother’s funeral. What is the SINGLE best descriptor for this patient’s behaviour?

A 29 year old women is averly paranoid that her partner is being unfaithful to her. She checks his phones, email accounts and bank statements several times a day for evidence of infidelity. She dislikes him going out as she fears that he would look at other women while he is out on his own. She does not allow any social media for fear that he may meet other women. What is the SINGLE most likely diagnosis?

A 34 year old schizophrenia man has been treated with risperidone for the past 2 months. He develops the sensation of restlessness and is unable to sit still. He is unable to relax and feels anxious. He fidgets and often has to pace around the room to feel relieved. When sits down, he repeats movements such as crossing and uncrossing his legs. What is the SINGLE most likely diagnosis?

A 64 year old woman has been brought by her son for psychiatric evaluation. She says that she has stopped living with her husband because she is convinced that it is someone else posing to be him. What is the SINGLE most likely condition she is suffering from?

A 10 year old boy with behavioural problems is taken to the clinic by his parents. During the appointment, the boy barks and shouts expletives. He is constantly blinking his eyes and unable to sit still. What is the SINGLE most likely diagnosis?

A 16 year old girl was brought to Accident and Emergency with the complaint of an episode of a sudden loss of consciousness. This occurred while shopping with her mother a few hours ago. The episode lasted for less than a minute followed by full recovery. There was no head injury. The mother informed the staff that her daughter had not eaten anything for the last four days because she is extremely fanatic about losing weight. She began a strict diet and exercise regimen to lose weight a few months ago. Her mother appears distressed as she has tried everything to get her daughter to eat but to no avail. The patient herself is adamant that she is fat and that her goal is to lose weight until she is 35 kg. The patient has no past medical history of note and is not taking any regular medications. On examination, the patient was found to be sweaty and wearing a baggy dress.

Weight 49 kilograms

Height 165 centimetres

BMI 18 kg/m2

Capillary blood glucose 2.1 mmol/L

It was proposed that the patient be admitted but when the subject was broached to the patient, she began to scream and demanded to be released. What is the SINGLE best treatment option in this patient?

A 27 year old woman finds herself with palpitations and dizziness whenever she is in a meeting at the office. She is very self-conscious and feels that her colleagues are judging her in a harsh way in meetings. She has been asked to present in one of the meetings but she called in sick to avoid being criticised. What is the SINGLE most likely diagnosis?

A 29 year old health care assistant was recently admitted for a cholecystectomy. After the procedure she becomes really upset because she is still experiencing abdominal pain. She begins to throw bedside objects at the surgeons because she is so frustrated that she went ahead with the surgery. She self discharges from the hospital. She has several old scars on her wrists. She has no history of substance abuse. A week later, she returns to the hospital to thank the surgeons as the pain has now resolved. What is the SINGLE most likely diagnosis?

A 65 year old woman thinks she has died 3 months ago and is very distressed that nobody has buried her up till now. She hears people’s voices which tell her that is evil and needs to be punished. She barely has any eye contact when speaking to the health care professionals. She speaks with a low voice. She has chosen to be very socially isolated over the past few months. Her previous visits have included symptoms of feelings of guilt and personal inadequacy. What is the SINGLE most likely explanation for her symptoms?

A 35 year old woman attends the GP surgery with low moods, tiredness and lack of enthusiasm. She has been having persistent sadness for 4 months. She finds very little pleasure in her day and has low energy. She has lost all interest in socialising. She finds it difficult to sleep and feels exhausted in the morning. She had a similar event of depression when she was 21 years old, requiring fluoxetine for 2 years. She remembers being admitted to the psychiatric ward when she was 28 years old because she had abnormal elevated moods and was extremely irritable. During that episode, she had extravagant plans and hallucinations. She was prescribed medication during that period but has forgotten to take it over the past few years. She is not on any medications currently. What is the most appropriate action?

A 28 year old female who delivered 6 weeks ago feels sad and has no interest in feeding her baby. She has been eating poorly and having difficulty sleeping. She feels weak throughout the day and has stopped taking the baby out of the house. She also says that the baby has evil eyes. What is the SINGLE most likely diagnosis?

A 64 year old man has a firm belief that the person on the billboard outside his window is sending a messages that are meant specifically for him. What is the SINGLE most likely type of delusion that this man is suffering from?

A 33 year old woman is brought in to the Emergency Department with coarse tremors, nausea, vomiting, and abdominal pain. She is known to have bipolar affective disorder and is currently taking 600 mg of lithium carbonate twice a day. She has been feeling lethargic for the past week. She has a temperature of 38.1°C and a heart rate of 85 beats/minute. On examination, she looks drowsy with impaired concentration. Her blood results show:

Sodium 140 mmol/L

Potassium 4.5 mmol/L

Urea 7 mmol/L

Creatinine 140 μmol/L

eGFR 60

Calcium 29 mmol/L

What is the SINGLE most likely cause of her presentation?

A 29 year old primary school teacher is seen in the psychiatric clinic with his girlfriend. He was first diagnosed with bipolar disorder 5 years ago and has been stable on lithium and quetiapine. He was started on sertraline 5 months ago following a depressive episode. He looks restless and is seen pacing around the room speaking quickly. His girlfriend states that he has been spending more than usual over the past few months and bought her a new car. He says he has not been sleeping well but does not feel the need to sleep. He has quit his job as a teacher to work on his new invention that could “replace traditional teaching in school”. During the consultation, he claims to be a close friend of the president of Canada. He denies suicidal

Which is the most appropriate advice?

ideation or thoughts of self-harm.

An 18 year old boy is in the reception awaiting his clinic appointment. He finds it difficult to speak to the receptionist to ask how long he has to wait. He speaks with a flat intonation. He avoids eye contact with people. He has sat at the back of the clinic avoiding other people in the clinic. He is very anxious about being in the reception with other people. He appears to be unaware when people talk to him. The receptionist had told him that the wait will be 5 minutes as he is the next one to be called. He expresses annoyance at the receptionist because he had to wait 15 minutes. He also became very anxious and upset when one of the other patients touched his shoulder to ask if he was alright. He has a background of not socializing well with his friends. He does well academically in university. What is the SINGLE most likely diagnosis?

A mother brings her 8 year old son to her GP worried about his development. Her son has been having increasing difficulties at school. He is unable to concentrate at his work and often gets distracted. His teacher describes him as restless and “constantly running around”. He often interrupts conversations and can get quite emotional and confrontational if asked to behave more politely. There have been several crying outbursts when he gets frustrated. Physical development has been described as normal. What is the most likely diagnosis?

A 32 year old woman has been taking an antipsychotic medication for her schizophrenia symptoms for the last 2 months. She attended the clinic describing stiffness in her right arm and she is unable to move it as easily as she used to. She also mentioned that she started experiencing jerky movements in the same arm about a week ago. She does not take any other medication and is otherwise well. Cogwheel rigidity is seen on physical examination. What is the most suitable medication to be prescribed to alleviate her

Symptoms?

A 32 year old woman complains of abdominal pain, shortness of breath, palpitations, unsteadiness, and numbness of the lower limbs. These symptoms have been on going for several months. An ECG, chest x-ray, abdominal ultrasound and neurological exam has returned with normal results. What is the SINGLE most likely diagnosis?

A 52 year old woman has been depressed ever since her husband died 1 year ago. She was started on citalopram by her GP 6 months ago to help battle her depression. She started to feel better and sleep well after 3 months of starting citalopram. She still thinks about her husband occasionally and the thoughts bring her mood down but she has drastic improvements as compared to a few months ago. She wants to know if she can stop the medication. What is the SINGLE best advice to give her?

A 33 year old man presents to the GP surgery with low mood and suicidal thoughts over the past month. He feels he needs urgent help. He has a history of self-harm from when he was a teenager. He has a medical history of bipolar disorder and he was admitted to the psychiatry ward a few years ago. He has been disengaged from mental health services. He drinks between 5 to 10 units of alcohol a day and smokes cannabis on a daily basis. He lives alone and has poor social connections. What is the SINGLE most appropriate initial management?

A 37 year old man was recently sent to jail for breaking all the windows of a shop with his bat. When the manager tried to stop him, he hit the manager on the head. He has a history of many convictions and has been imprisoned many times. He finds it difficult to keep close relationships. He has 2 boys with his ex-wife but does not contact them. What is the most SINGLE most likely diagnosis?

A 28 year old schizophrenic man refuses to let his father into the house because he has the delusion that his father has been replaced by an identical looking impostor. He easily recognised other family members but would only misidentify his father. What is the SINGLE most likely condition he is suffering from?

A 19 year old boy attends the Emergency Department with confusion and agitation. He has been feeling lightheaded. He looks amused at the medical staff’s shirts and the chairs in the department. He has been staring at a clock on the wall for the past 10 minutes. He describes the clock as distorted and the colour of the clock keeps changing. He admits to taking a substance a few hours ago given to him by one of his friends at a dinner party. His heart rate is 99 beats/minute, his temperature is 38°C and his respiratory rate is 16 breaths/minute. On examination, he looks sweaty and dazed. What is the SINGLE most likely substance that he has consumed?

A 23 year old man feels anxious and agitated when faced with stress. He has an interview in 3 days and would like some help in relieving his symptoms for the interview. What is the SINGLE most appropriate management?

A 23 year old nurse presents suffering from anxiety and insomnia. She finds it very difficult to control her emotions. At times, she becomes very angry over issues which are small. She becomes very impulsive when she is angry. She describes a chronic feeling of emptiness. She reveals she has not had many friends because she finds it very difficult to build relationships. She does not seek emotional support from her parents. She has a past medical history of autism. She has no other significant medical history. What is the most appropriate management?

A 33 year old woman has this intense fear that someone would break into the house. She lives alone. Every night she has to check the lacks 30 times before she goes to bed. If she checked it any less, she would not be able to sleep because of the fear that someone would come in. This fear has developed over the past two years. What is the SINGLE most appropriate diagnosis?

A 32 year old woman is brought to the Emergency Department by ambulance in an agitated state. The ambulance crew gives you the handover that her neighbours had seen her roaming around the streets throwing money and shouting she is going to die. She refuses to let any health care come close to her to perform observations or to take her blood. She is unable to answer any of your questions. At the end of every question, she laughs hysterically and repeatedly shouts that she smokes, drinks and walks amongst aliens. It is deemed that she does not have the capacity to make decisions and a compulsory admission under the Mental Health Act is performed. She continues to be agitated and attempts to run away from the hospital but is stopped by security. Which is the SINGLE most appropriate medication to administer?

A 73 year old woman has been seen wandering the streets at 3 am confused and lost. She was found by the police and brought to the hospital. She lives alone and last her husband to cancer 3 years ago. Her son who lives nearby was called and asked to come in. The son reports that she has been having a deterioration of her memory over the period of 4 years but it has worsened dramatically since she lost her husband. She has very low moods and does not eat or drink well. She has difficulty concentrating. She has been hearing voices of her late husband recently in the house and she feels guilty that she was unable to convince him to go to the doctors earlier before his cancer was widespread. What is the SINGLE most likely reason for her hallucinations?

A 64 year old man has just suffered from a myocardial infarction. Before discharge, he seems to be in a low mood, with feelings of worthlessness and avoids eye contact. The nurses report that he has skipped his last two meals. This information was included in the discharge summary to the GP. He also has a history of benign prostatic hyperplasia and hypertension. What is the SINGLE best treatment for this man’s condition?

The neighbour of a 65 year old man has called the police because the man has been behaving strangely. He believes that he is dead and smells like rotten meat. He believes his bowels are not functioning and are slowly ratting. He has been refusing to eat and drink over the past few days. He lacks interest in his daily activities and has very little social interaction. He lives alone and has last gone out a few months ago. He has no history of mental illnesses. What is the SINGLE most likely explanation for his symptoms?

A 33 year old man with extreme moods which alternates between elevated and depressed underwent treatment and some improvement was seen. What SINGLE medication is needed to be continued to prevent his alternating moods?

A 22 year old man is distressed that he hears the voice of his deceased uncle telling him that he is being spied on. He feels low in mood and anxious. He has not left the house for 2 weeks and has recently starting to drink increasing quantities of alcohol due to his anxiety. His speeches are interrupted with silence for a few seconds followed by topics unrelated to what was being discussed. He feels he is no longer in control of his own body and thoughts. What is the SINGLE most suitable medication to treat his symptom?

A 25 year old woman gets severe anxiety when she goes out of the house. She has palpitations, sweats excessively, feels breathless and has the sensation as if she was about to die every time she goes out. These symptoms started 2 years ago when she was assaulted in the street. She now associates leaving the house with being attacked in the street. These fears prevent her from visiting relatives and friends. What is the SINGLE most likely diagnosis?

A 38 year old man keeps having intrusive thoughts about having dirt under the bed. He cannot keep himself from thinking about these thoughts. If he tries to resist, he starts having palpitations. His thoughts have been worsening over a 6 month period. He does not sleep well because of these intrusive thoughts. The only relief he gets is if he vacuums the dirt under his bed. He has to do this several times a day. He has recently lost his job because he is constantly late for work as he cleans his bedroom floor constantly. He has been having low moods since he lost his job. What is the SINGLE most likely diagnosis?

A 33 year old woman is preoccupied with the trustworthiness of one of her colleagues. She says that her colleague has been threatening her at work and at home. She has distrust and is suspicious of his motives and believes he intends to harm her. She has a sense of insecurity when around her colleague. She has been having these beliefs for a few months. She works as a medical secretary. She denies the use of illicit drugs. What is the SINGLE most likely diagnosis?

A 21 year old girl presents to the Emergency Department after collapsing in the house. She is very slim and has a BMI of 14kg/m2. She states that she is only eating vegetables, and has been reducing fat in her diet because she is trying to lose weight before her holiday. She does not think that she is underweight and does not want to have treatment. She does not want to be admitted under any circumstance. Her thoughts are coherent. On examination, she has calluses on the backs of her hands and fine hair on her arms. She has a heart rate of 45 beats/minute and blood pressure of 95/60 mmHg. Blood tests show the following:

Sadium 122 mmol/L (135-145)

Potassium 3.0 mmol/L (3.5-5)

Urea 6 mmol/L (2.0-7)

Creatinine 80 μmol/L (70-150)

eGFR 90 mL/min (>90)

What is the most appropriate management?

A 33 year old man with a history of depression has been having low moods for the past 4 weeks. He feels hopeless and wants to end his life. He has a history of self-harm where he cut his wrist two years ago with the intention to end his life. His father suffered from a similar depression history and committed suicide at age 58. He recently quit his job as an investment banker. He has been taking sertraline for the past 6 months. Which SINGLE piece of information increases his risk of suicide?

A 34 year old patient was admitted for severe depression and suicidal thoughts. He attempted to commit suicide. He has been on sertraline for the past year which he had stopped a month ago. He had been admitted in the psychiatric ward two years ago for mania. On discharge, the patient wishes to know if he can be started on a long-term medication to alleviate his symptoms. What SINGLE medication will be most useful for his disorder?

A 20 year old man complains his movements are being watched. He feels as though his actions are being controlled by the radio. At times he hears voices describing his actions. What is the SINGLE most likely diagnosis?

A 24 year man finds it difficult to come out of his house without checking if he has locked the door several times. When exits his house, he has to check it at least 3 times by pushing the door handle to confirm it is locked. He now wants help as he has been doing this for a couple of years. What is the SINGLE most appropriate management?

A 61 year old man has been suffering from a low mood for the past 2 years. He has lost interest in his hobbies. He feels fatigued most of the time. He has poor concentration and low self-confidence. He has regular visits with his psychologist. His medical history includes orthostatic hypotension and benign prostatic hyperplasia. He takes regular tamsulosin. He has not taken any antidepressants before. What is the SINGLE most appropriate medication to prescribe for his depression?

A 33 year old man tries not to go outside his house because he thinks that people will look at him and talk about him. He finds difficulty when talking with his peers in a restaurant or under social settings. He sweats and feels palpitations when speaking to strangers. He dislikes going to malls as he fears strangers may criticise his looks. He avoids these situations as they cause him distress. What is the SINGLE most likely diagnosis?

A 29 year old man has been found in the park, drunk and brought to the emergency department by ambulance. He recently lost his job and had a divorce 3 months ago. He has intense feelings of feeling worthless and being a failure. He also hears voices telling him he is worthless. What is the SINGLE most likely diagnosis?

A 28 year old woman complains of hearing strange voices in her bedroom as she is falling asleep in the night. She says there is no one in the room except for her. She is otherwise healthy and without mental illness. What is the SINGLE most likely diagnosis?

A 61 year old man presents to his general practitioner (GP) with a low mood. Further questioning reveals that he has been feeling low for the last 6 weeks and has lost interest in his daily activities. He lacks energy which is causing him difficulty in carrying out his daily activities. He also describes being unable to sleep at night and attributes this to feeling lethargic during the day. He admits to not having much of an appetite anymore and to a two-kilogram weight loss in this period. He has been widowed for two years and currently lives alone. He finds it difficult to concentrate on tasks at home. He has no suicidal or self-harm intentions. The patient’s medication list includes tamsulosin which he takes for benign prostatic hyperplasia. His blood pressure is measured as 122/82 mmHg (supine) and 98/71 mmHg (standing). What is the SINGLE best class of drug that should be offered in this patient?

A 22 year old woman with pre-existing bipolar disorder delivered 3 days ago by caesarean section. She has been suffering from low moods and insomnia for the past 3 days. She has mixed anxiety and at times feels that the midwives are trying to harm her baby. At other times, she has intrusive and unpleasant thoughts of harming her baby. These thoughts come from voices when no one is around. When she hears these voices, she would pace around the room very worried. What is the SINGLE most likely diagnosis?

A 33 year old nurse has been having anxiety and low moods over the past few months. She has lost interest in the activities she would usually enjoy. She has not been going to work because she feels worthless. She has been avoiding social events. She is tearful at night and finds difficulty sleeping. She feels fatigued and reports difficulty with concentration. What is the SINGLE most appropriate management?

A 62 year old man has uncontrollable lip smacking, puckering, repetitive chewing movements and tongue thrusting. He also has uncontrollable slow writhing movements of his fingers. He is on long-term antipsychotic medications for the past 15 years as part of the management of his schizophrenia. What is the SINGLE most likely diagnosis?

A 36 year old woman contacts the police to notify them that she was responsible for a recent disastrous flood which had resulted in loss of lives. What is the SINGLE most likely kind of delusions she is suffering from?

A 71 year old woman looks disheveled, unkempt and with poor eye contact. She has recently lost her husband 2 months ago. She feels hopeless and has been tearful all week. Which SINGLE option describes her condition?

A 26 year old woman has a history of bipolar disorder for 10 years and is taking lithium for it. She has been symptom free for the past 4 years. She is now planning her pregnancy and wants to know whether she should continue to take lithium. What is the SINGLE most appropriate advice?

A 33 year old woman diagnosed with schizophrenia is admitted to the psychiatric ward. She reports an inability to think clearly, attributing it to the belief that the nurse is actively taking away her thoughts. What is the SINGLE most likely phenomenon associated with her experience?

A 27 year old man presents with symptoms characterized by alternating mood swings associated with flight of ideas, and overactivity. He has been going out very often and has made a few big purchases, one of which is a new car. Three months ago he had low moods with lack of energy and did not go out for months. What is the SINGLE most likely diagnosis?

A 19 year old man accuses his friend of making his right arm swing out to hit a stranger at the park. There is no evidence of this as his friend was at home at that time. What is the SINGLE most appropriate term to describe his condition?

A 68 year old man comes into Accidents and Emergency confused and with nausea and a coarse tremor. He had a few episodes of vomiting and diarrhoea earlier in the day. As the emergency doctor is taking a history, he slowly becomes unconscious. His partner gives a history that he took an overdose of a medication but she is unsure which medication it was. He suffers from bipolar disorder. Which of the following medications could account for his symptoms?

A 36 year old male patient has had severe depression for the past two months. He initially presented as a case of attempted suicide six weeks ago when he was found by his brother and his wife trying to overdose on paracetamol tablets. He has since seen a psychiatrist and started on a trial of a selective serotonin reuptake inhibitor (SSRI). Unfortunately, the SSRI appears to have had no improvement on his symptoms. A consult with the patient reveals a man who refuses to meet your eyes. The patient also has poverty of speech and thinks that he is a burden on his family and that life is not worth living. What is the SINGLE most appropriate next step in this patient’s management?

A 18 year old man washes his hands 6 times every time he uses the toilet. On his way out of the toilet, he has to switch off the light, turn it back on and turn it off once more. He has an intense fear if he does not check if the lights were turned off. On examination, he has a normal speech and good eye contact. He continuously rubs his hands. What is the SINGLE most appropriate management?

A 33 year old man has been suffering from depression around the same time every year. He starts feeling low at the beginning of the winter months. He loses interest in most of his usual activities during these months. He also feels lethargic, gains weight and becomes more tearful. When winter finishes, his moods begin to improve. These low moods have occurred for the past 5 years. What is the SINGLE most likely diagnosis?

An 28 year old man attends the Emergency Department as he has been feeling low for the past several years. He is tearful and feels hopeless. He describes himself as having very little motivation in life. He denies having many close friends or relationships. He believes that the only real relationship he has had is with his girlfriend which ended 10 years ago. He recently started a new job in a warehouse 2 weeks ago and would like to rapidly elevate his mood to keep his job. He has changed jobs a few times over the last decade. He denies alcohol intake or drug misuse. He has no thoughts of suicide or self- harm. He lives with his mother in a house. He is not on any medications. What is the SINGLE most appropriate action?

A 18 year old boy was recently sent to juvenile detention center after he set his father’s car on fire. He lacks remorse for setting the car on fire and says he would do it again if he had the chance to. He has always found it difficult to conform to social rules and has no regard for the rights of others. What is the SINGLE most likely diagnosis?

A 25 year old female has just been diagnosed with bipolar disorder. The psychiatric team is considering commencing her on lithium carbonate treatment. Before being commenced on lithium, the patient is required to go for a variety of blood tests. A blood request form has been given to her for calcium levels and a renal function test. What is the SINGLE most appropriate test to send this patient for in addition to the ones listed?

A 23 year old woman is having issues with her weight and figure. She believes that her body habitus is large and feels that she needs to lose more weight. Her body mass index is 16 kg/m2. She has had frequent visits to the GP to ask for laxatives over the past year. She would like to achieve a target BMI of 15 kg/m2. Her blood pressure is 110/70 mmHg. Her heart rate is 65 beats/minute. What is the SINGLE most appropriate management?

A 22 year old woman was brought to the A&E by her friends. She presents with tremors. On examination, she was found to have a temperature of 37.4°C and her pupils dilated. She says when she closes her eyes, she can see colours. What is the SINGLE most likely drug that has been taken?

A 52 year old woman speaks rapidly without any pause and ignores interruptions. She barely even pauses to take enough breaths. What is the SINGLE best term to describe this kind of speech?

A 55 year old woman has been taking amitriptyline for the past 6 weeks to help cope with the death of her husband. Her husband had died from pancreatic cancer. She reports that she has seen a vast improvement in her symptoms and intends to stop the medication. She asks you to order a CT scan of her abdomen to rule out pancreatic cancer as she is worried about this. The nurse informs you that the patient has called multiple times during the week concerned about pancreatic cancer. What is the most appropriate action?

A 33 year old man attends his appointment with the psychiatrist. He says that he is no longer alive. He wants his family to bury him. What is the SINGLE most appropriate diagnosis?

A 42 year old schizophrenic man presents with neck stiffness and muscle spasm which started a few days ago. He also complains of increasing rigidity of both his arms and noticed a slight tremor since yesterday. He has been apyrexial and his vitals are stable. His medication list includes aripiprazole which was recently dispensed. Which is the SINGLE most appropriate medication to prescribe?

A couple attends a marriage counselling session because of marital problems. The wife states that her husband is having affairs although she has no proof of this. The husband states that she is “insane” because she is having him followed by a private detective and she is overly preoccupied about him being unfaithful. She goes through his personal belongings almost every day to look for signs of infidelity. Her actions are putting considerable strain on their marriage. What is the SINGLE most likely syndrome she is suffering from?

A 19 year old woman is brought to the hospital by her parents. They are concerned about her weight. Her body mass index is 12.1 kg/m2. She has a mildly depressed mood and has low self-esteem. She has been not had any menstrual periods for the past year. She has reduced her food intake in the past couple of months. She has a blood pressure of 70/50 mmHg and a heart rate of 44 beats/minute. What is the SINGLE most appropriate management?

A 43 year old woman presents with low mood, and loss of libido. She feels tired all day and she attributes this to the fact that she wakes up 3 hours sooner than usual. She feels like she has been gaining weight. She also finds it difficult to concentrate for long periods of time. What is the SINGLE most likely diagnosis?

A 30 year old man who served in the army 6 months ago presents with lack of interest in enjoyable activities and feeling low. During his time in the army, he was involved in combat-related trauma. He often wakes up in the middle of the night because of nightmares of gunfire. He feels irritable and has difficulty concentrating. He has intrusive images of war once a week. He tries not to watch the news as it reminds him of war. What is the SINGLE most appropriate initial therapy?

A 29 year old teacher was run down by a drunk driver a year ago. Since then, she has been afraid to cross the road. She suffers from nightmares about that incident and gets a startled response every time she hears loud sounds. What is the SINGLE most appropriate initial management?

A 42 year old man attends the Emergency Department with a 2 day history of a stiff neck. He feels his muscles being increasingly stiff. His friend who has brought him in says that he is more confused today. His medical history includes schizophrenia which he was started on risperidone orally two weeks ago. He has a temperature of 38.2°C and a heart rate of 110 beats/minute. What is the SINGLE most likely diagnosis?

A 38 year old biochemist with a diagnosis of schizophrenia believes that every time his colleague wears a blue scarf, aliens are being sent to monitor his actions. What is the likely phenomenon?

A 48 year old man attends his GP surgery. He was started on fluoxetine 8 weeks ago for depression and is now requesting to stop his medication as he feels well and does not think he is depressed any longer. What is the SINGLE most appropriate advice to give to him in regards to his treatment?

A 33 year old man feels his own heart pounding and feels anxious whenever he passes a bus stop. He has been avoiding bus stops for the past 18 months. 2 years ago he was attacked in the bus stop and was stabbed in his thigh while waiting for a bus. He blames himself for being there in the bus stand when the attack occurred. He often has nightmares reliving the event in the middle of the night. What is the SINGLE most likely diagnosis?

A 14 year old girl was found by her mother collapse on the floor at home and brought to the Emergency Department. She was found on the floor at home but regained consciousness just before the paramedics arrived. She gives a history of increasing fatigue and intolerance to cold over the past few weeks since joining the gym 2 months ago. On further questioning, her mother says that she found laxatives and diuretics in her daughters room and is concerned about it being the cause of her collapse. She denies her weight being an issue despite having a body mass index of 15 kg/m2. She has a systolic blood pressure of 85 mmHg and a heart rate of 55 beats/minute. During examination, it is noted that she finds it difficult to get up from a lying position without using her hands. What is the SINGLE most likely reason for her symptoms?

A 38 year old man has had low mood, lack of energy and poor motivation in his daily activities for the past 4 months. He describes the feeling of a “black hole” when discussing his future and believes that his future will be unpleasant. He has stopped exercising over the past few months. He works as a carpenter. He drinks around 10 units of alcohol a day and has been dependent on alcohol. There are some days he binges on alcohol. Which gives the highest risk of death from suicide?

A 33 year old man hears his mother calling out his name only when he is about to fall asleep. This would startle him and he would wake up to find no one there in the room. What is the SINGLE most likely phenomenon?

A 37 year old woman believes that her neighbours have been using her shower while she is away at work. She is convinced that they dry the bathroom and escape just before she goes into the bathroom. Her husband comes to share the same belief and informs the police. What is the SINGLE most appropriate term for these symptoms?

A 21 year old man was brought by his friends unconscious from a party where he was said to have drank vodka. While he was being attended to by the doctor in the Emergency Department, he became conscious and said the green tie the attending doctor was wearing was talking to him. His friends also mention that an hour earlier he mentioned that he was seeing sounds coming out of the radio. On examination, his pupils are dilated. What substance could this patient have taken which could account for his symptoms?

A 25 year old woman is recovering in the postnatal ward after having delivered her first child 2 days ago by an emergency C-section for placental abruption. She feels overwhelmed with the responsibility of looking after her newborn. She has been suffering from symptoms of severe depression aver the past few days. She is disoriented and feels that the medical staff are planning on taking her baby away to a different country. She never leaves the baby on the cat because she fears that as soon as she does, the government would steal her baby. At times, she herself has intrusive thoughts of her harming her baby. Her brother states that their mother suffered from a similar condition. She has no family members in the UK to help her look after the baby. She was well before the delivery of her baby. Among the options, which is considered the best management for this condition?

A 28 year old woman presents with feeling anxious for most days throughout the past 6 months. She feels distress when thinking about money and her job. She is unable to sleep well and finds it difficult to concentrate at work. On occasion, she panics and she feels she is about to die. On examination, her blood pressure is 120/80, pulse rate is 90 beats/minute. What is the SINGLE most appropriate medication to prescribe?

A 15 year old girl presents to the GP clinic accompanied by her mother. She has a history of having low moods for the past 3 months since she moved to a new school. She misses her friends and does not get along well with the students in the new school. She has lost interest in her usual activities like horse riding and swimming which she used to enjoy. She finds it difficult to sleep at night and becomes tearful. What is the SINGLE most appropriate management?

A 68 year old woman has been admitted to the psychiatry ward with poor appetite, weight loss, poor concentration and self neglect for 3 weeks. She has not been eating or drinking adequately and has rarely left her bed. She expresses suicidal ideas and hears voices telling her she is worthless. She has been on antidepressant therapy for the past 3 months with no improvement. She has little verbal response. What is the SINGLE most appropriate management?

A 34 year old woman started having palpitations, sweating, tremors and difficulty breathing at work while having lunch at her desk when her colleagues walked into the room, chatting loudly. She describes the event as having a “funny turn”. Her hands had become numb during the episode. She had the fear of being spoken to and wanted to avoid her colleagues. She had just returned to work on that day after a long period of covid lockdown restrictions where she was working from home. What is the SINGLE most likely diagnosis?

An 18 year old boy attends the Emergency Department as he has been feeling law for the past 10 days. He is a college student and had just separated from his longstanding girlfriend of 3 years. He has not been sleeping well over the past two nights because he has been thinking of his girlfriend. He finds it difficult to concentrate on his college work since the separation. He has no suicidal ideation. He has a good amount of friends who have been seeing him every day. He lives in a single room in the college accommodation. What is the SINGLE most appropriate action?

A 16 year old boy has been performing poorly in school since moving to a new school. He lacks interest and has very little social interactions. He has very few friends and finds it difficult to express himself. He prefers solitary activities. His teachers often complained that he is seen organising his stationaries on his table while counting to twenty each time and if disrupted, he would be very upset and anxious. One of his interest is collecting toy cars. He has over 2,000 toy cars and often spends hours lining them up. What is the SINGLE most likely diagnosis?

A 6 year old child is brought to the clinic by his mother. She says that his teacher complains that he is easily distracted and interrupts others when it is their turn to answer questions. His mother says that he is not able to do a particular task for a long time and cannot play quietly. He is careless and often breaks things. He shows aggression and talks excessively. He has always had difficulty concentrating since he was a young child. What is the SINGLE most likely diagnosis?

A 35 year old man was brought in by his wife to the Emergency Department as he was seen shouting at his neighbours with confusion in the morning. He becomes more confused and aggressive in the department while waiting to be seen by the medical staff. He starts pushing people away from him and shouting at patients. He believes the medical staff are trying to steal his wallet and his identification. Medical history was not obtained yet. What is the SINGLE most appropriate medication to administer for to manage his aggression?

A 30 year old schizophrenic female attacks her mother believing that aliens have replaced her with an exact double. What is the SINGLE most likely condition she is suffering from?

A 25 year old woman has had several sudden onset episodes of palpitations, sweating, and fear. She notices her hands shake when they occur. These episodes occur almost everyday and sometimes can wake her from her sleep. They can last 20 to 40 minutes. She has no previous psychiatric disorder and is not on any medications. She does not take recreational drugs. What is the SINGLE most likely diagnosis?

A 16 year old girl with anorexia is taken to the medical unit with her parents with concerns regarding lethargy and dizziness. Her blood pressure is 90/60 mmHg. She has a pulse of 50 beats/minute and a temperature of 37.1°C. Her ECG shows an irregular heart rhythm. Her body mass index is 14 kg/m2. The girl is refusing all treatment and her father is opposed to hospital admission. What is the SINGLE most appropriate management?

Joseph who is a 24 year old man with a history of depression has been having low moods for the past few months. He feels hopeless and wants to end his life. He has a history of attempted suicide in the past where he hung himself from the fan but his mother quickly cut the rope down. He has recently ended his two-year relationship with his girlfriend. He has been taking sertraline for the past 3 years. Joseph’s father suffered from a similar depression history and committed suicide when he was at age 40. At that time, Joseph was only 10 years old. Which of the following piece of information from his history is most likely to lead to another suicide attempt?

A 23 year old woman has had several sudden onset episodes of palpitations, sweating, nausea and overwhelming fear. On one occasion she was woken from sleep and had the fear that she was going insane. She has no previous psychiatric medical history and is not on any medication. What is the SINGLE most likely diagnosis?

A 56 year old chronic alcoholic man wants to attend his daughter’s wedding in 2 weeks and does not want to be drinking during the wedding. He says he is determined to quit drinking alcohol but wants extra help. What is the SINGLE most appropriate medication?

A 25 year old woman presents to the GP with low mood. She has an increased appetite and has gone up 2 dress sizes. She also complains that she feels very tired and often only gets out of bed in the afternoon despite sleeping early. Her moods improve with positive events although not to a “normal” level. What is the SINGLE most likely diagnosis?

A 44 year old man was involved in a road traffic accident and fractured his right femur. He was admitted by the orthopaedic team and underwent post-intramedullary nailing. On his 2nd day of admission, he develops confusion and starts profusely sweating. He reveals that he has been an alcoholic who consumes an average of 20 units a day but has stopped since admission. On examination, he is disoriented. His examination findings include nystagmus and hyperreflexia. His blood pressure is 160/100 mmHg and his heart rate is 110 beats/minute. His blood test show the following:

Gamma-glutamyl transferase (GT) 220 u/L (8-60 U/L)

Alkaline phosphatase (ALP) 180 iu/L (30-150 U/L)

What is the SINGLE most appropriate management?

A 21 year old man is seen in the Psychiatry clinic with the complaint of strange body movements. His mother describes his body movements as unconventional and inappropriate. They consist of lip-smacking, protrusion of his tongue and quick, shaking movements of his hands and feet. The patient cannot control these movements. His past medical history is significant for schizophrenia, diagnosed a year ago. The patient states that he was started on medication for his schizophrenia several months ago however he does not take his medication regularly as he sometimes forgets to take it. What is the SINGLE best treatment for this patient’s condition?

A 24 year man finds it difficult to come out of a room without having to turn the light switch off and on 3 times. He has tried more than several times to go out of the room without having to do this particular compulsion however he still returns to the room feeling agitated that it was not done. He is worried about losing her job as a teacher because of his impulse which is uncontrollable. What is the SINGLE most appropriate management?

A 34 year old man who is a known schizophrenic has been going through a depressive phase for the past few months since the death of his father. During discussions with his siblings and friends, he is seen laughing and smiling inappropriately while talking about his father’s death. He does not seem to realise that his actions are inappropriate. What is the SINGLE most appropriate term that describes his symptoms?

A 33 year old man has recently had a divorce. For the past 3 months, he has been feeling incredibly low. He has not been eating well and finds it difficult to sleep at night on most days. He does not enjoy his normal activities as he had once done. He has been socially distant from his friends. He denies any thoughts of suicide or self-harm. He finds it difficult to concentrate when people talk to him. He feels worthless since his wife has left him. He drinks an estimate of 10 units of alcohol a week. He works as an engineer of which he says his work has not been significantly impaired. What is the SINGLE most appropriate management?

A 32 year old schizophrenic lady complains that she hears voices saying “she is evil”. What is the SINGLE most likely type of hallucinations involved?

A 74 year old man is depressed after his wife’s death 6 months ago. He has been neglecting himself and is not eating well. He has lost 11 kg in the last 3 months. At times, he has thought about self harm but has never done it. His son found him in a very miserable state when he went to visit him last night. Unfortunately, the son is unable to care for his father due to work and other family related issues. What is the SINGLE most appropriate management?

A 25 year old man gets severe anxiety when he boards trains or goes to the shopping mall. He would have palpitations, feels nauseous and feels the need to escape as soon as he enters trains or malls. This has been ongoing for the past 3 years and has been progressively worsening. What is the most appropriate management?

A 33 year old woman presents to her GP because of low moods. She has difficulty sleeping and feels tired at work. She refuses to go out with her friends and rather spends time resting on her bed. She is eating less and has lost 8 kg in the last 10 weeks. A year ago, she was productive, full of energy, optimistic, needed very little sleep and always wanted to go out. She had grand ideas about herself and was full of new ideas. Her BMI is 27 kg/m2. What is the SINGLE most likely diagnosis?

A 55 year old man is brought to the GP surgery by his wife for a review of a growth on his forehead. His wife wants the growth removed but he refuses and says that the growth helps him think clearly. What is the SINGLE most appropriate next course of action?

A 57 year old school teacher has had a repair of a strangulated femoral hernia 3 days ago. She has become agitated, aggressive and very confused over the past 12 hours. She has developed auditory hallucinations. She is unable to differentiate between reality and her hallucinations. Her blood tests show the following:

Haemoglobin 129 g/L (115-160 g/L)

Mean cell volume (MCV) 112 FL (76-96 FL)

Gamma-glutamyl transferase (GT) 120 u/L (8-60 U/L)

Alkaline phosphatase (ALP) 110 iu/L (30-150 U/L)

What is the SINGLE most appropriate management?

A 44 year old woman is admitted for an elective herniorrhaphy. She tells the medical team that she is a heavy alcohol drinker and her last alcoholic drink was 6 hours ago. She is determined to stop drinking. On average, she drinks 15 units of alcohol a day. Her blood tests show the following:

Haemoglobin 119 g/L (115-160 g/L)

Mean cell volume (MCV) 102 FL (76-96 FL)

Gamma-glutamyl transferase (GT) 150 u/L (8-60 U/L)

Alkaline phosphatase (ALP) 155 iu/L (30-150 U/L)

What is the SINGLE most appropriate medication to prescribe her to reduce alcohol withdrawal symptoms?

A 38 year old woman who gave birth 6 weeks ago presents to her local GP surgery with her husband. She describes ‘crying all the time’ and ‘not bonding’ with her baby. She is worried about baby’s health constantly and she is unsure if is able to cope with this new change in her life. What is the SINGLE most likely diagnosis?

Josephine who is an 11 year old girl lives with her mother who suffers from depression. Josephine’s parents divorced 3 years ago after which her mother started becoming severely depressed requiring antidepressants. Since the divorce, Josephine’s mother has feelings of hopelessness and low esteem. Josephine is about to move to a new secondary school. Which is the most significant risk factor for Josephine to develop depression in the next few years?

A 32 year old woman has increased energy over the past few weeks. She has a decreased need for sleep and racing thoughts. She has recently bought a house and a new car. She reports that she has been more productive at work and has started several new projects. She often starts a task at home but cannot finish it as she has difficulty focusing on one task alone. She noticed that her sex drive has also increased. What is the SINGLE most likely disorder?

A 33 year old schizophrenic says the following. “Life is unfair, I eat air, lawn chair, I like fairs, fairs have food, it must be good, in adulthood, I misunderstood”. What term describes this patient’s speech?

A 43 year old man attends the GP clinic complaining that his arm is dead and rotten and he wants it removed. He has very poor eye contact and stares at the floor majority of the consultation. On physical examination, the arm looks normal. What is the SINGLE most appropriate diagnosis?

A 48 year old woman was found unconscious by the window cleaner in her apartment, holding an opened bottle of medications. She had overdosed on paracetamol and took precautions to make sure she was not found. The police had to break down the door as it was locked. She was alone in the flat when she took the averdose. She did not contact anyone before or after the overdose. She lives alone. She was brought to the hospital by the paramedics. She had taken 25 tablets of paracetamol. Which is the most significant factor in her history for a completed suicide at a future date?

A 35 year old chronic alcoholic has been trying to stop his alcohol drinking habit. He has been going for support meetings. He wants to know if there is a medication that can help reduce his alcohol cravings. What is the SINGLE most appropriate medication?

A 48 year old man states he is a well-known professor teaching rocket science in a London university. He states that the number of people who attend are within the thousands and they would fly in from different parts of the world to hear his lectures. He states that he owns the majority of the United Kingdom and in a few years people would think of him as a god. What is the SINGLE most likely disorder?

A 30 year old woman has been feeling low and having difficulty concentrating since her mother passed away 2 months ago. She feels lethargic and has been crying more often lately. She has difficulty sleeping at night. She sleeps an average of 4 hours a night. She works as a school teacher but has not been able to return to work because of low moods. Her symptoms started 2 weeks after her mother passed away and have not subsided. What is the SINGLE most likely diagnosis?

A 22 year old female was brought to A&E by her friend with a complaint of nausea and flushing. They were at a birthday party and the patient had been drinking copious amounts of alcohol. The patient says that she can see spots of colour around her peripheral vision. A visual field examination and fundoscopy was performed and were determined to be normal. She feels energetic. She has no other medical problems and takes paracetamol on occasion for headaches. During the consult, the patient complains of being excessively thirsty and she consumes approximately one litre of water. Her vitals are as follows:

Blood pressure: 138/89 mmHg

Heart rate: 122/min

Respiratory rate: 22 breaths/min

Temperature: 37.9 °C

What is the SINGLE most likely drug that this patient has taken?

A 33 year old woman has been having thoughts and re-experiencing a traumatic event that has just happened a week ago. She had experienced a mass shooting in her office. The shooter shat 3 people in front of her. She started to feel anxious a few hours after the event and has not slept well since then. She avoids speaking about her office as it reminds her of the event. What is the SINGLE most appropriate diagnosis?

A 33 year old man is brought into the Emergency Department by the police as he has been walking around threatening patients in the GP surgery. He has been verbally abusing the patients saying they are psychopaths for frequently using the NHS. He strongly believes that he is able to save the NHS by reorganising services and allowing only “deserving” patients to use the service. He speaks quickly and cannot be interrupted. Halfway through the conversation, he burst into tears, expressing the need for his involvement in the UK government to change the NHS. He has not slept for the past 3 days thinking about solutions to save the NHS. He has no previous history of psychiatric illnesses. What is the SINGLE most likely diagnosis?

A 22 year old woman thinks she is overweight. She has a body mass index of 21.8 kg/m2. She often experiences constipation and abdominal pain. She eats uncontrollably and feels guilty resulting in self-inducing vomiting. Sometimes to compensate for her big meal, she would exercise intensively. What is the SINGLE most likely diagnosis?

A 34 year old man with a history of mania has further manic episodes despite taking a maximum regular dose of haloperidol. Following his manic episodes, lithium was started and he was advised to have a blood test to check lithium levels in 7 days. What is the SINGLE most appropriate advice regarding checking lithium levels?

A 64 year old man has recently suffered from an a myocardial infarction 5 months ago. He has been having trouble sleeping and seems depressed. His regular medications include aspirin, atorvastatin and ramipril. What is the SINGLE most appropriate medication to start him on?

A 19 year old college student has a firm and unshakable belief that he is being followed by terrorists who are plotting against him. He says they follow him wherever he goes. What is the SINGLE most appropriate term for his condition?

A 38 year old woman with a history of hypothyroidism, severe depression and bipolar affective disorder presents to the Emergency Department with coarse tremors and muscular twitching. She feels nauseous and drowsy. She had vomited three times a few hours before presenting to the Emergency Department. She has brought in a bag full of the medications she would normally take with one of the medication boxes completely empty. Her heart rate is 92 beats/minute. She has ataxia and seems confused. Which is the SINGLE most likely medication responsible for her symptoms?

A 21 year old woman has had several sudden onset episodes of palpitations, sweating, nausea, chest pain and overwhelming fear. On one occasion, she was woken from sleep and feared she was going insane. She has no previous psychiatric disorder. She has multiple attendances to the Emergency Department because of the fear of death from a heart attack. What is the SINGLE most likely diagnosis?

A 30 year old man complains of episodes of hearing music and threatening voices within a couple of hours of heavy drinking with his friends at a friends birthday party. What is the SINGLE most likely diagnosis?

A 82 year old schizophrenic man is brought to the Emergency Department in an agitated state. He is lashing out violently and throws any equipment around him at the hospital staff. He seems to be hearing voices which are causing him distress. He does not have any intravenous access. Which is a drug of choice in the management of agitation in this man?

A 44 year old alcoholic was admitted for alcohol intoxication. He has been treated and he is now planned for discharge. He admits to not being able to spend a day without drinking. Which of the following statements is most likely to suggest that this man may be still dependent on alcohol?

A 28 year old woman has episodes of perioral tingling and carpopedal spasms every time she has to give a public talk. These symptoms also happens to her before interviews, exams and after arguments. She describes these episodes as short lasting only a couple of minutes but with intense fear. What is the SINGLE most appropriate management to prevent further episodes?

A 17 year old woman has been told that she has anorexia nervosa previously which she has been managing with self-help books. She is brought into the GP clinic by her father who is concerned that she is losing more weight over the past few months. She has mild depressive symptoms and has reduced her food intake in the last 8 months. She exercises daily and admits to inducing vomiting occasionally after a meal. Her body mass index is 14.8 kg/m2. She has a blood pressure of 95/65 mmHg and an ECG performed in the clinic shows a sinus rhythm with a heart rate of 70 beats/minute. What is the SINGLE most appropriate management?

A 22 year old woman was brought to the emergency department by her boyfriend with her fist bleeding after punching a mirror. She is distressed because he wants to end the relationship. Scars of old cuts on her forearms were noticed during a physical examination. She drunk 3 battles of wine before cutting herself. She denies trying to end her life. What is the SINGLE most likely diagnosis?

A 24 year old man feels down and lethargic. In the last couple of months, he has stopped enjoying his hobbies which include playing the violin. He was admitted to the psychiatry ward last year following an episode of overspending, reckless behaviour and promiscuity. Three years ago he was suffering from major depression and took an overdose of paracetamol. What is the SINGLE most likely diagnosis?

A 21 year old woman is followed up for her mental health by the psychiatric team. She gave birth to her first baby 5 weeks ago. Since then she feels she is unable to cope with looking after her baby. She is seen crying all the time. She has very low moods and finds no pleasure in life. She feels very anxious about looking after her newborn as well as isolated and unable to relate to other people. At times, she has intrusive thoughts of harming her baby. What is the SINGLE most likely diagnosis?

A 21 year old woman was brought to the Emergency Department by her boyfriend. She has many self inflicted superficial lacerations on her forearm. She is distressed and constantly says her boyfriend is going to end the relationship. She denies trying to end her life. What is the SINGLE most likely diagnosis?

A 36 year old woman has been admitted to a psychiatric ward and expresses a strong belief that the staff and other patients possess complete knowledge of her thoughts at all times. What is the SINGLE most likely phenomenon associated with her belief?

An 18 year old girl with a body mass index of 17.8 kg/m2 has bilateral parotid swelling with thickened calluses on the dorsum of her hand. What condition would present with these features?

A 16 year old boy has been binge eating over the past 2 weeks. He eats excessively, even when not hungry. He does not stop eating even at the point of abdominal discomfort. He feels extreme guilt and regrets after eating. His guilt does not result in actions such as inducing vomiting, taking laxatives or excessive exercise. He is content with his weight. He has a BMI of 27 kg/m2. What is the SINGLE most likely diagnosis?

A 58 year old man is admitted into the hospital following dehydration and severe vomiting after given a course of chemotherapy to treat his advanced prostate cancer. Over the past 24 hours, he has become agitated and paranoid. He believes that the nursing staff are putting marijuana in his food. On admission, he was prescribed intravenous metoclopramide to be administered three times a day. On examination, he has incoherent speech with little insight into his illness and the presence of extrapyramidal muscle rigidity. His heart rate is 110 beats/minute, a temperature of 39.1°C and his blood pressure is 160/105 mmHg. His blood results show the following:

Haemoglobin 132 g/L (130-180)

White cell count 15 x 10″/L (4-11)

Neutrophils 4 x 10°/L (2-7.5)

Platelets 350 x 10″/L (150-400)

Serum urea 8.5 mmol/L (2.0-7)

Serum creatinine 160 μmol/L (70-150)

eGFR >90 mL/min

Calcium 2.2 mmol/l (2.1-2.6)

Sodium 138 mmol/L (135-145)

Potassium 3.8 mmol/L (3.5-5)

Alkaline phosphatase (ALP) 130 U/L (30-150)

Alanine transferase (ALT) 32 U/L (5-35)

What is the SINGLE most likely diagnosis?

A 33 year old man has had sleepless nights over the past few weeks. He is seen pacing around the room with rapid, incoherent speech. He keeps talking about moving to Canada to find a new job and purchasing a house there. He has recently spent his savings on a new car. He has a belief that he would quickly rise to the top of the political party in Canada. He has been having these thoughts over the past 3 weeks. He has difficulty focusing on his work due to his thoughts. What is the SINGLE most appropriate diagnosis?

A 28 year old woman comes in with her limbs paralysed after witnessing a car accident. She cannot recall what just happened. What is the SINGLE most likely diagnosis?

A 52 year old female presents to her GP with feelings of low mood. It was determined during the consult that she didn’t want to attend the appointment but came because her husband insisted. She describes a 4 month period of feeling low. In addition, she describes experiencing difficulty falling asleep at night and feeling lethargic all the time. She mentions not having much of an appetite anymore. She used to spend lots of her spare time writing children’s’ books but she says that she does not find pleasure in that anymore. She works as a financial consultant and says that her concentration at work has become impaired and that her work is suffering as a result. The GP made a diagnosis of moderate depression and started fluoxetine which she has been taking for 8 weeks. She has also been attending cognitive behaviour therapy. After 8 weeks, the patient returns with the same symptoms of low mood and no improvement in functional ability. What is the SINGLE next best step in management for this patient?

A 41 year old male patient was rushed to Accident & Emergency (A&E) with a Glasgow coma scale (GCS) of 13/15 following an incident that happened during a long haul flight. The patient was flying from Thailand to the United Kingdom when he started feeling nauseous followed by having a tremor and becoming confused. He has been taking regular ibuprofen 400 mg for his lower back pain for the past week. The patient’s past medical history is significant for bipolar disorder. He has been taking lithium for the past 10 years and is well controlled on it. What is the SINGLE most appropriate test to do for this patient?

A 28 year old woman witnessed a tragic road traffic accident where a young boy was killed by a lorry. On the night of the event, she was not able to sleep as she had horrid thoughts of the event. The following morning, she woke up and was not able see. She has no previous history of medical or psychological issues. What is the SINGLE most likely diagnosis?