Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 456 questions.
A 46-year-old woman was admitted as a voluntary patient to an authorised psychiatric hospital in Perth three days ago with a severe depressive episode. This mor…
Psychiatry · Pre-internship · middle twist
A 34-year-old woman attends a Perth general practice for insomnia. On direct questioning she says her partner pushed her into a wall last week, checks her phone…
Psychiatry · Pre-internship · middle twist
A 7-year-old boy is brought to a Perth emergency department by his mother with a spiral fracture of the left humerus. He also has a healing circular burn on the…
Psychiatry · Pre-internship · middle twist
You are the intern on an adult inpatient psychiatric unit. At the morning meeting the occupational therapist reports that a woman due for discharge tomorrow cou…
Psychiatry · Pre-internship · middle twist
A 44-year-old man with treatment-resistant schizophrenia has taken clozapine 400 mg at night for six years and smokes 30 cigarettes a day. He is admitted to a s…
Psychiatry · Pre-internship · middle twist
A 31-year-old man with schizophrenia has had four admissions in 18 months. He lives alone in a boarding house, keeps about one clinic appointment in five, and e…
Psychiatry · Pre-internship · middle twist
You are the intern on a surgical ward. A 68-year-old woman, four days after mastectomy, tells the night nurse she may as well not wake up in the morning. She ha…
Psychiatry · Pre-internship · middle twist
A 16-year-old girl has been treated for a first episode of psychosis and is well on aripiprazole. She missed most of Year 11 and wants to return part time. Her…
Psychiatry · Pre-internship · middle twist
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