Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 456 questions.
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
A 27-year-old man with schizophrenia is assessed at home in Perth after his sister contacted the community mental health team. He stopped his olanzapine six wee…
Psychiatry · Pre-internship · niche
A 31-year-old woman is reviewed at home by the perinatal mental health team three weeks after the birth of her first child. She has not slept for four nights, h…
Psychiatry · Pre-internship · middle twist
An 86-year-old man who lives alone is brought to the emergency department by his daughter because he has been muddled for two days and twice called her by his l…
Psychiatry · Pre-internship · middle twist
A 78-year-old woman is on day six after an elective right hemicolectomy. Since the second postoperative day she has had episodes lasting about twenty minutes in…
Psychiatry · Pre-internship · niche
A 74-year-old man has been in hospital for ten days with a severe depressive episode. He is convinced that his bowel has rotted away and that he is being punish…
Psychiatry · Pre-internship · middle twist
Police bring a 54-year-old man to the emergency department at 2 am after he shouted at passing cars and swung at an officer. He is known to the mental health se…
Psychiatry · Pre-internship · middle twist
A 58-year-old man is brought to a regional emergency department after threatening a neighbour with a length of timber. He is shouting, will not sit, and has twi…
Psychiatry · Pre-internship · middle twist
A 78-year-old man admitted a fortnight ago with a first psychotic illness had his risperidone increased from 1 mg to 3 mg daily seven days ago. Since then he ha…
Psychiatry · Pre-internship · middle twist
A 22-year-old apprentice is brought to a regional emergency department by friends at 11 pm after telling them he wanted to die. Six hours later his breath alcoh…
Psychiatry · Pre-internship · middle twist
A 76-year-old woman was admitted five days ago with a severe depressive episode. Her general practitioner started amitriptyline 75 mg at night three weeks ago a…
Psychiatry · Pre-internship · middle twist
A 24-year-old man admitted with a first episode of psychosis started olanzapine six days ago and had the dose increased four days ago; he has also taken sertral…
Psychiatry · Pre-internship · niche
You are the intern covering the orthopaedic ward at 2 am. A 79-year-old man, two days after hemiarthroplasty for a fractured neck of femur, is climbing over the…
Psychiatry · Pre-internship · middle twist