Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 309 questions.
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 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 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
A 29-year-old woman is seen at home on day nine after the birth of her first child. Her husband says she has not slept for three nights, is talking rapidly abou…
Psychiatry · Pre-internship · middle twist
A 17-year-old boy was assessed six weeks ago with four months of social withdrawal and fleeting suspiciousness, and was referred for psychological therapy. He r…
Psychiatry · Pre-internship · middle twist
A 29-year-old woman attends for the fourth time in six months with headache, abdominal pain and difficulty sleeping. Investigations at the previous visits were…
Psychiatry · Pre-internship · middle twist
A 24-year-old man with schizophrenia has had three admissions in eighteen months. He receives paliperidone palmitate by monthly injection at the clinic and ever…
Psychiatry · Pre-internship · middle twist
A 44-year-old man has adjustment disorder with anxious mood following a workplace investigation. Over eight weeks he has completed six sessions of cognitive beh…
Psychiatry · Pre-internship · middle twist
A 34-year-old woman has been treated for adjustment disorder with depressed mood for ten months, since her only son sustained a spinal cord injury and she becam…
Psychiatry · Pre-internship · middle twist
A 79-year-old woman lives alone in the house she owns. She tells the general practice registrar that her grandson shouts at her when he visits and has twice sho…
Psychiatry · Pre-internship · middle twist