Master Specialist Psychiatry (PSY5961)
for DHA Speciality

A 24-year-old woman is brought to the emergency department by her partner. She has had 5 days of decreased need for sleep, rapid pressured speech, and grandiose claims that she has been chosen to lead a global movement. She reports hearing voices commenting on her actions. She has no prior psychiatric history and no substance use. Vital signs: BP 118/74 mmHg, HR 92/min, temperature 37.1?C. Laboratory: TSH 1.8 mIU/L (0.4-4.0), urine toxicology negative, urine pregnancy test positive. Which is the most appropriate next step in management?

A 68-year-old man with a 3-year history of Parkinson's disease on levodopa/carbidopa is admitted with 2 weeks of visual hallucinations of small animals, fluctuating attention, and daytime somnolence. He has no fever and no focal neurological deficit. Vital signs: BP 132/80 mmHg, HR 78/min, temperature 36.8?C. Laboratory: WBC 7.2 x109/L, CRP 4 mg/L, creatinine 1.0 mg/dL. Which is the most appropriate next step in management?

A 32-year-old woman with a 6-month history of major depressive disorder is started on sertraline 50 mg daily. Two weeks later she presents with confusion, agitation, diaphoresis, and tremor. She reports she also took linezolid for a skin infection started 3 days ago. Vital signs: BP 158/96 mmHg, HR 118/min, temperature 38.6?C. Laboratory: creatine kinase 1,850 U/L (30-200), WBC 11.5 x109/L. Which is the most likely diagnosis?

A 45-year-old man with schizophrenia on clozapine 300 mg daily for 8 weeks presents with 2 days of fever, sore throat, and malaise. Vital signs: BP 110/70 mmHg, HR 104/min, temperature 38.4?C. Laboratory: WBC 2.1 x109/L, absolute neutrophil count 0.9 x109/L, CRP 28 mg/L. Which is the most appropriate next step in management?

A 29-year-old woman with bipolar I disorder on lithium carbonate for 2 years presents with 3 days of coarse tremor, vomiting, and unsteady gait. She recently started ibuprofen for back pain. Vital signs: BP 108/68 mmHg, HR 88/min, temperature 37.0?C. Laboratory: lithium level 2.4 mmol/L (0.6-1.2), creatinine 1.6 mg/dL (baseline 0.9), sodium 138 mmol/L, TSH 2.0 mIU/L. Which is the most appropriate next step in management?