Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 488 questions.
A 19-year-old university student with anorexia nervosa is admitted to a medical ward weighing 38 kg (body mass index 14.2 kg/m2). Her heart rate is 40 beats per…
Psychiatry · Pre-internship · middle twist
A 41-year-old woman has had panic attacks with avoidance of buses and shopping centres for two years. Another doctor started diazepam 5 mg twice daily eight mon…
Psychiatry · Pre-internship · middle twist
A 58-year-old woman who came to Australia from Afghanistan four years ago is brought to the emergency department by her adult son. For a week she has cried most…
Psychiatry · Pre-internship · middle twist
A 15-year-old girl has lost 11 kg over eight months. She eats from a short list of permitted foods, exercises for two hours daily and says she is still too fat;…
Psychiatry · Pre-internship · middle twist
A 29-year-old woman known to the community mental health service comes to the emergency department at 11 pm after an argument with her partner. She is tearful a…
Psychiatry · Pre-internship · middle twist
A 26-year-old woman has presented to the emergency department nine times in two years after cutting her forearms. She describes chronic emptiness, intense and u…
Psychiatry · Pre-internship · middle twist
A 38-year-old woman has a third depressive episode. It began four months after her mother died and she moved interstate for work, leaving the friends and commun…
Psychiatry · Pre-internship · middle twist
A 71-year-old woman is receiving right unilateral electroconvulsive therapy three times a week for melancholic depression. After the fifth treatment she is eati…
Psychiatry · Pre-internship · middle twist
A 23-year-old woman with bipolar I disorder has had two manic episodes in 18 months and stopped lithium because of intolerable tremor and polyuria. The psychiat…
Psychiatry · Pre-internship · middle twist
A 27-year-old man with schizophrenia remains persistently deluded and hears voices for most of each day. He has completed eight weeks of risperidone 6 mg daily…
Psychiatry · Pre-internship · middle twist
A 58-year-old woman telephones the practice at 5 pm. She has read an online news article claiming that a medicine she has taken for three years has been linked…
Psychiatry · Pre-internship · middle twist
A 46-year-old man taking venlafaxine 225 mg daily for depression is admitted after a fall at work. The orthopaedic team started slow-release tramadol two days a…
Psychiatry · Pre-internship · niche
A 29-year-old woman is admitted with a first manic episode. She has not slept for four nights, has telephoned strangers at 3 am and has spent her rent money on…
Psychiatry · Pre-internship · niche
A 32-year-old man with bipolar I disorder has been euthymic for three years on sodium valproate 1200 mg daily, after two manic admissions in his twenties. At a…
Psychiatry · Pre-internship · niche
A 46-year-old man with schizophrenia has taken clozapine 400 mg daily for four years without a dose change. Over the past ten days he has become drowsy in the a…
Psychiatry · Pre-internship · niche
A 22-year-old man with a first psychotic episode has taken olanzapine 10 mg daily for six weeks. His delusional beliefs have largely resolved and he has returne…
Psychiatry · Pre-internship · middle twist
A 52-year-old woman who arrived in Australia from Afghanistan eleven months ago attends a community mental health clinic for review of post-traumatic stress dis…
Psychiatry · Pre-internship · common
A 27-year-old man with schizophrenia has taken amisulpride 1200 mg daily for ten weeks and, before that, olanzapine 20 mg daily for twelve weeks. Both were give…
Psychiatry · Pre-internship · middle twist
A 41-year-old man with bipolar I disorder is brought to a Perth community mental health clinic by his mother, who wants him put in hospital. He stopped lithium…
Psychiatry · Pre-internship · middle twist
You are the resident medical officer in a regional Western Australian emergency department at 2 am. Police have brought in a 34-year-old man found walking along…
Psychiatry · Pre-internship · middle twist