Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 488 questions.
A 62-year-old man is reviewed in the cardiology clinic eight weeks after an anterior myocardial infarction. He meets criteria for a moderate depressive episode…
Psychiatry · Pre-internship · niche
A 22-year-old university student had her first episode of psychosis nine months ago and has been in full remission on aripiprazole for the past seven months. Sh…
Psychiatry · Pre-internship · middle twist
A 27-year-old man with schizophrenia took risperidone 6 mg daily for ten weeks and then olanzapine 20 mg daily for twelve weeks. His case manager supervises eac…
Psychiatry · Pre-internship · middle twist
A 21-year-old man is brought to a regional emergency department at 2 am by police after he was found standing on a freeway overpass. He says a voice has been te…
Psychiatry · Pre-internship · middle twist
A 17-year-old is brought to the general practitioner by his father, whose own brother has schizophrenia. Over eight months the boy's grades have fallen, he has…
Psychiatry · Pre-internship · middle twist
A 26-year-old woman is reviewed at home on day 8 after the birth of her first child. Over three days she has slept about two hours a night, talks rapidly about…
Psychiatry · Pre-internship · common
An 81-year-old widow has told her general practitioner at three visits over four months that a neighbour lets himself into her flat at night and moves her furni…
Psychiatry · Pre-internship · middle twist
A 24-year-old man is admitted at 11 pm with a first episode of psychosis. He has had six weeks of persecutory beliefs and voices commenting on his actions, and…
Psychiatry · Pre-internship · middle twist
A 21-year-old student is brought to the emergency department at 3 am by his housemates. He has slept two hours in three days and has drunk eight cups of coffee.…
Psychiatry · Pre-internship · middle twist
A 24-year-old man is brought to the emergency department at 2 am by police. He has been using methamphetamine for three days, and is pacing, sweating and shouti…
Psychiatry · Pre-internship · middle twist
A 63-year-old woman has taken slow-release morphine for eighteen months for pain from vertebral metastases, prescribed and reviewed monthly by her oncologist. S…
Psychiatry · Pre-internship · niche
A 27-year-old man attends a community drug and alcohol service at 9 am asking to start buprenorphine. He has injected heroin daily for four years and last injec…
Psychiatry · Pre-internship · middle twist
A 54-year-old man is admitted eighteen hours after his last drink, anxious, sweating and coarsely tremulous, with a pulse of 108/min and a blood pressure of 150…
Psychiatry · Pre-internship · middle twist
A 41-year-old woman stabilised on methadone 80 mg daily for opioid dependence has had open reduction and internal fixation of an ankle fracture. Four hours late…
Psychiatry · Pre-internship · middle twist
A 29-year-old man who has injected heroin daily for six years has completed a seven-day inpatient withdrawal. He is medically well and has declined both methado…
Psychiatry · Pre-internship · middle twist
You are the intern on a geriatric ward. An 84-year-old woman admitted six days ago with pneumonia was disorientated and inattentive for her first three days; sh…
Psychiatry · Pre-internship · middle twist
A 79-year-old man attends with his wife for the results of a memory assessment, which has confirmed mild Alzheimer disease. He lives at home, manages his own fi…
Psychiatry · Pre-internship · middle twist
A 76-year-old man with dementia with Lewy bodies has become convinced that his son is stealing from him and has started accusing and shoving care staff. Over th…
Psychiatry · Pre-internship · niche
An 88-year-old man on a medical ward has a delirium precipitated by pneumonia and is receiving appropriate antibiotics. Overnight he is terrified by figures he…
Psychiatry · Pre-internship · middle twist
A 79-year-old woman with moderate Alzheimer disease in residential care has become resistive over the past week. She shouts and pushes staff away during showeri…
Psychiatry · Pre-internship · middle twist