Middle twist
One twist — a threshold, a comorbidity, an atypical presentation. 776 questions.
A 17-year-old with attention deficit hyperactivity disorder has taken immediate-release methylphenidate 10 mg at 8 am and 10 mg at 1 pm for two years, sleeping…
Psychiatry · Pre-internship · middle twist
A 45-year-old man with major depressive disorder has been treated for seven weeks and his mood has clearly improved. He now reports intensely vivid, unpleasant…
Psychiatry · Clinical rotations · middle twist
A 68-year-old retired plumber is brought by his wife, who says that for eight months, mostly in the hours before dawn, he shouts, kicks and swings his arms whil…
Psychiatry · Pre-internship · middle twist
A 14-year-old girl attends a Western Australian general practice on her own for what she calls a check-up. During the consultation she tells you she has been ha…
Psychiatry · Pre-internship · middle twist
A 15-year-old girl is brought to a regional emergency department by her mother after fainting at school. Over five months she has cut all fats from her diet and…
Psychiatry · Pre-internship · middle twist
A 24-year-old primary school teacher is referred because of painless swelling at the angles of both jaws over four months. She is 165 cm tall and weighs 61 kg,…
Psychiatry · Clinical rotations · middle twist
A 22-year-old woman presents to the emergency department having cut her forearms after an argument with her flatmate. She describes two hours in which she felt…
Psychiatry · Pre-internship · middle twist
A 29-year-old woman was admitted three weeks ago unable to walk. Magnetic resonance imaging of brain and whole spine, nerve conduction studies and cerebrospinal…
Psychiatry · Pre-internship · middle twist
A 26-year-old woman has been an inpatient for three weeks with recurrent bloodstream infections through her central venous catheter, growing a different mix of…
Psychiatry · Pre-internship · middle twist
A 38-year-old labourer has been off work for nine months with back pain after a workplace lift, and his compensation claim is being contested. On examination he…
Psychiatry · Pre-internship · middle twist
A 34-year-old operating theatre nurse has had eight admissions in a year with episodes of sweating and confusion. Today her blood glucose is 1.6 mmol/L (3.0 to…
Psychiatry · Clinical rotations · middle twist
A 30-year-old woman is brought to the emergency department unable to walk after a heated argument with her mother. Her right leg lies flaccid and she cannot lif…
Psychiatry · Pre-internship · middle twist
A 46-year-old man has consulted five doctors in two years convinced he has bowel cancer. He has had three colonoscopies, all normal, and inspects his stool ever…
Psychiatry · Clinical rotations · middle twist
A 33-year-old woman has had five months of nightmares, flashbacks and hypervigilance since her partner strangled her. She still lives with him and was assaulted…
Psychiatry · Pre-internship · middle twist
A 24-year-old man avoids parties, will not eat in the staff cafeteria, cannot bring himself to ask a shop assistant for help, and has turned down a promotion be…
Psychiatry · Pre-internship · middle twist
A 58-year-old man is on the surgical ward on the second day after an elective inguinal hernia repair. He is anxious and sweating, his hands tremble, and he has…
Psychiatry · Pre-internship · middle twist
A 27-year-old man with obsessive compulsive disorder has checking rituals that make him two hours late for work most days. He completed 16 sessions of cognitive…
Psychiatry · Pre-internship · middle twist
A 29-year-old woman is seen at home on day 10 after an uncomplicated birth. She describes repeated images of stabbing her baby that come into her mind while she…
Psychiatry · Pre-internship · middle twist
A 20-year-old warehouse worker has spent five hours a day washing since he handled a leaking drum of solvent three months ago. He is certain he will poison his…
Psychiatry · Clinical rotations · middle twist
A 29-year-old man with bipolar I disorder is reviewed in the community mental health clinic. He was admitted at 22 with a manic episode and stopped lithium thre…
Psychiatry · Pre-internship · middle twist