A 65 year old woman has low mood, hopelessness, anhedonia, poor concentration, low energy, insomnia, lack of appetite and suicidal ideation for 8 weeks. Which is the most appropriate management?

Correct Answer: D

Rationale: In this scenario, the most appropriate management for the 65-year-old woman presenting with symptoms of depression and suicidal ideation for 8 weeks would be option D) Sertraline, a selective serotonin reuptake inhibitor (SSRI) commonly used to treat depression. Sertraline is a recommended first-line treatment for major depressive disorder due to its efficacy in improving mood, reducing suicidal ideation, and addressing associated symptoms like poor concentration, low energy, and sleep disturbances. SSRIs are often preferred over tricyclic antidepressants like Amitriptyline (option A) due to their more favorable side effect profile and safety in overdose situations. While therapy modalities like Cognitive Behavioral Therapy (CBT) (option B) and Psychodynamic Therapy (option C) are valuable adjuncts to pharmacological treatment for depression, in acute cases with significant suicidal ideation, initiating medication like Sertraline is crucial for immediate symptom relief and risk reduction. Educationally, understanding the rationale behind choosing the appropriate medication in psychiatric emergencies is vital for healthcare professionals working with individuals experiencing mental health crises. This case highlights the importance of timely intervention, risk assessment, and evidence-based treatment selection to ensure the safety and well-being of patients in crisis.

Correct Answer: B

Rationale: In the context of psychiatric emergencies, it is crucial to consider the possibility of non-accidental injuries, especially in vulnerable populations like the elderly. The correct answer, B) Non-accidental injury, is the most likely explanation for the bruising in this case. Elder abuse, including physical abuse resulting in bruising, is unfortunately common and often underreported. Option A) Bleeding disorder is less likely in the absence of a history of bleeding tendencies or anticoagulant use. Occult malignancy, option C, typically presents with more generalized symptoms rather than localized bruising. Scurvy, option D, is rare in developed countries and is associated with a deficiency in Vitamin C, which would usually present with additional symptoms like poor wound healing and swollen gums. Educationally, understanding the signs and symptoms of elder abuse, including non-accidental injuries, is crucial for healthcare providers, especially those working in emergency departments or psychiatric settings. Recognizing and addressing such issues promptly can prevent further harm to the patient and ensure their safety and well-being.

Correct Answer: A

Rationale: The correct answer is A) Hyperthyroidism. In this case, the woman presents with symptoms such as secondary amenorrhea, weight loss, and increased appetite, which are indicative of hyperthyroidism. Hyperthyroidism can disrupt the normal menstrual cycle and metabolism, leading to weight loss despite increased food intake. Hypogonadism (B) is characterized by decreased or absent gonadal function, leading to hormonal imbalances and menstrual irregularities. However, the symptoms presented in the case are more indicative of hyperthyroidism rather than hypogonadism. Polycystic ovary syndrome (C) typically presents with symptoms such as irregular periods, weight gain, and hormonal imbalances. While weight gain is a common symptom in PCOS, the weight loss described in the case is not consistent with this diagnosis. Premature ovarian failure (D) is characterized by the loss of ovarian function before the age of 40, leading to symptoms such as irregular periods and infertility. While it can cause amenorrhea, the rapid weight loss and increased appetite in the case suggest a different diagnosis. In an educational context, understanding the differential diagnosis of secondary amenorrhea is crucial for healthcare providers, especially in psychiatric emergencies where physical health conditions may manifest with psychiatric symptoms. This case highlights the importance of considering endocrine disorders like hyperthyroidism in the evaluation of menstrual irregularities and weight changes. Healthcare professionals must be able to recognize the subtle differences in symptoms to provide accurate diagnosis and appropriate treatment.

Correct Answer: B

Rationale: In this scenario, the most appropriate topical treatment for a 38-year-old woman presenting with red sore eyes with crusting in the morning for 9 days is option B) Antibacterial. The rationale behind this choice is that the symptoms described suggest a possible bacterial infection such as bacterial conjunctivitis, commonly known as pink eye. Antibacterial eye drops or ointment would be the most effective treatment to address the underlying infection. Option A) Anaesthetic is not the best choice in this case because it would only provide symptomatic relief by numbing the eye and would not treat the underlying cause of the symptoms. Similarly, option C) Antiviral would not be appropriate unless there is a confirmed viral infection, which is not indicated based on the symptoms described. Option D) Mydriatic is used to dilate the pupil and would not be the correct choice for treating a bacterial eye infection. In an educational context, it is crucial for healthcare professionals to be able to differentiate between various eye conditions and select the most appropriate treatment based on the presenting symptoms. Understanding the indications for different types of eye medications is essential in providing effective care for patients with eye complaints. By choosing the correct treatment, healthcare providers can help alleviate symptoms, promote healing, and prevent potential complications.

Correct Answer: D

Rationale: The most appropriate long-term treatment for a 32-year-old woman experiencing intermittent palpitations, paraesthesia, breathlessness, and dizziness for 6 months is option D) Propranolol. Propranolol is a beta-blocker commonly used to treat symptoms of anxiety, such as palpitations and tremors, by reducing the effects of adrenaline on the body. In this case, the symptoms described suggest an underlying anxiety disorder, and propranolol can help alleviate physical symptoms associated with anxiety. Option A) Amitriptyline is a tricyclic antidepressant that may be used to treat anxiety disorders, but it is not the first-line treatment for symptoms like palpitations and dizziness. Option B) Diazepam is a benzodiazepine used for acute anxiety relief or panic attacks, not recommended for long-term use due to the risk of dependence and tolerance. Option C) Moclobemide is a reversible inhibitor of monoamine oxidase A (RIMA) used in the treatment of depression and social anxiety disorder, but it is not the first choice for the symptoms described. In an educational context, understanding the rationale behind selecting the appropriate medication for psychiatric emergencies is crucial for healthcare providers, especially in psychiatric settings or emergency departments. Recognizing the specific symptoms and matching them with the most suitable medication is essential for effective treatment and patient care. Propranolol's mechanism of action in managing physical symptoms of anxiety makes it a suitable choice in this scenario, highlighting the importance of tailored treatment approaches in psychiatric care.