Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 309 questions.
A 79-year-old woman is an inpatient on a psychiatric ward being treated for a depressive episode. She is oriented, gives a coherent account of her illness and i…
Psychiatry · Pre-internship · middle twist
A 79-year-old man was prescribed temazepam 10 mg at night when his wife died four months ago, to help him sleep for a few nights. He has taken it every night si…
Psychiatry · Pre-internship · middle twist
An 80-year-old woman with moderate Alzheimer disease in residential care has been agitated and wandering at night for five days, and is drowsy during the day. S…
Psychiatry · Pre-internship · middle twist
An 82-year-old woman with mild dementia is admitted from home with three days of confusion that fluctuates and is worse at night. She is drowsy but rousable and…
Psychiatry · Pre-internship · middle twist
An 84-year-old man with mild Alzheimer disease is brought to the emergency department by his daughter. For two days he has been drowsy after lunch and then agit…
Psychiatry · Pre-internship · middle twist
A 15-year-old girl has lost 12 kg over five months and eats about 600 kcal a day. She is alert, has attended school all week, and her parents can start family-b…
Psychiatry · Pre-internship · middle twist
A 16-year-old girl has had major depression for five months. She has completed 10 sessions of cognitive behavioural therapy but still cannot attend school, has…
Psychiatry · Pre-internship · middle twist
A 16-year-old boy is brought by his father because he has gone from the top of his class to failing in six months. He has quit the swimming squad, sleeps until…
Psychiatry · Pre-internship · middle twist
A 12-year-old girl has moderate intellectual disability and speaks only in single words. Her family has just moved to Perth. A chromosomal microarray was sent t…
Psychiatry · Pre-internship · middle twist
A 16-year-old boy is brought to the emergency department by police after he held a kitchen knife towards his mother during an argument about his phone. He is no…
Psychiatry · Pre-internship · middle twist
A 15-year-old girl attends a Perth general practice alone and asks for the contraceptive pill. She explains accurately how it works and why it must be taken dai…
Psychiatry · Pre-internship · middle twist
A 13-year-old boy has been diagnosed with attention deficit hyperactivity disorder by a paediatrician, who recommends immediate-release dexamphetamine alongside…
Psychiatry · Pre-internship · middle twist
During the part of a consultation conducted without his parents, a 16-year-old boy tells you he smokes cannabis with friends most weekends. He is attending scho…
Psychiatry · Pre-internship · middle twist
A 28-year-old woman is admitted after an overdose. The team cannot decide between a recurrent depressive illness and a personality disorder. She gives a vague,…
Psychiatry · Pre-internship · middle twist
A 17-year-old boy is seen in the emergency department under police guard after seriously assaulting a stranger. Since primary school he has bullied other childr…
Psychiatry · Pre-internship · middle twist
A 41-year-old man with a long-standing diagnosis of borderline personality disorder is reviewed by his community team. Over the past five weeks he has woken at…
Psychiatry · Pre-internship · middle twist
You are the intern covering an orthopaedic ward at 11 pm on the third night after a 78-year-old woman's hip hemiarthroplasty. The nurse says she has not slept,…
Psychiatry · Pre-internship · middle twist
A 58-year-old man has slept poorly for three weeks since his brother died, and is now making errors at work. Sleep hygiene advice and relaxation training have n…
Psychiatry · Pre-internship · middle twist
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 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