KFP – Doctors’ health

Mark Lawson, aged 43, presents to your practice for a repeat prescription of his antihypertensive medication. During the consultation, he appears withdrawn and avoids eye contact. You notice he is less well-groomed than usual. When asked how things are going, he hesitates before disclosing he has been struggling with motivation, sleep, and feelings of worthlessness over the past few months. He reports these symptoms have been affecting his work as a GP in a busy suburban practice. He is finding it hard to concentrate and dreads going to work. He denies any current suicidal ideation but mentions that sometimes he thinks his patients would be better off seeing someone else.

Medications: Perindopril 5 mg daily

Allergies: Nil known

Past history: Hypertension (diagnosed 3 years ago)

Social history: Married with two children, no alcohol or illicit drug use, no smoking. Regular exercise has lapsed in recent months.

Psychiatric history: Nil

Preventative Healthcare: Up to date

Examination findings: No physical abnormalities noted. PHQ-9 completed in consult: Score 20 (severe depression)

What are the most appropriate next steps in management? Select three (3) from the following list:

Angela Tran, a 31-year-old hospital-based registrar, presents for a ‘routine check-up’ and requests a renewal of her oral contraceptive pill. During the consultation, she appears tense and exhausted. When asked how things are going, she becomes tearful and discloses that she has been struggling with intense anxiety, panic attacks before shifts, and persistent insomnia. She describes feeling overwhelmed by the demands of training, study, night shifts, and the pressure to appear competent. She frequently ruminates about making mistakes and fears being seen as weak if she seeks help. She has no thoughts of self-harm but admits to drinking 3–4 glasses of wine most nights to help her sleep.

Medications: Ethinyloestradiol/levonorgestrel

Allergies: Nil known

Past history: Nil significant medical or psychiatric history

Social history: Lives alone, no children, close to family interstate

Psychiatric history: Nil

Examination findings: No abnormalities on physical examination

What are the most appropriate next steps in management? Select four (4) from the following list:

James O’Connor, a 54-year-old GP with a solo rural practice, presents with new-onset chest discomfort that he describes as a tightness when walking uphill or under stress. He initially attributes it to ‘just stress’ but agrees to a review after pressure from his partner. On further discussion, he discloses he has been skipping meals, drinking heavily on weekends, and feels exhausted all the time. He admits to neglecting his own health checks and hasn’t seen another GP in over five years. He says he can’t take time off as there’s no one to cover his patients, and fears being judged if he’s seen to be unwell.

Medications: Nil

Allergies: Nil known

Past history: Nil documented

Family history: Father died of myocardial infarction aged 58

Social history: Lives with partner, drinks 6–8 standard drinks on Friday and Saturday nights. Smoker – 10/day. Sedentary lifestyle. No regular GP follow-up.

Examination findings: BP 152/95 mmHg, HR 82 bpm, BMI 28.3, mild epigastric tenderness, chest clear, ECG shows nonspecific ST changes

What are the most appropriate next steps in management? Select three (3) from the following list:

Priya Patel, a 29-year-old PGY2 doctor, presents to your clinic after receiving negative feedback from her registrar and feeling overwhelmed. She discloses that she has been having difficulty concentrating at work, is behind on documentation, and has had two near-miss incidents in the last fortnight. She reports waking early in the morning with a sense of dread, losing interest in food, and crying daily after her shifts. She worries that she is not cut out for medicine. She admits she hasn’t told anyone because she fears being labelled or having her registration affected. She lives with a supportive partner and denies any current thoughts of self-harm.

Medications: Nil

Allergies: Nil known

Past history: Nil significant medical history

Psychiatric history: Brief period of anxiety during final year of medical school, self-managed with exercise and support

Social history: Lives with partner, no alcohol or substance use. Good social support but reluctant to disclose mental health issues to colleagues.

Examination findings: Appears anxious and tearful. No psychomotor agitation or retardation. No suicidal ideation.

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Michael Han, a 47-year-old emergency physician, presents after his wife expressed concern about recent personality changes. She reports that he has become increasingly irritable, withdrawn, and has been sleeping poorly. He has also started working longer hours, often picking up extra shifts. Michael brushes off concerns and attributes his behaviour to ‘just being tired’. When you gently explore further, he discloses that he has been having intrusive thoughts about a recent patient death and feels personally responsible. He has begun avoiding resuscitation bays and reports feelings of dread before each shift. He denies suicidal ideation but admits to feeling numb and detached from his family.

Medications: Nil

Allergies: Nil known

Past history: Nil significant medical or psychiatric history

Social history: Married with two teenage children. No alcohol or drug use. Active community involvement.

Examination findings: Flat affect. Mildly anxious. No psychotic features or formal thought disorder.

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Hannah McLeod, a 62-year-old part-time GP, presents for a health check after retiring from her long-term practice six months ago. She reports struggling with a lack of purpose and increasing low mood. She admits to sleeping more during the day, withdrawing from social activities, and feeling tearful when alone. She has also noticed some memory lapses and difficulty concentrating, which she finds distressing. She denies any thoughts of self-harm or suicide. She has no regular GP and says she’s always been too busy caring for others to attend to her own health.

Medications: Calcium and vitamin D supplements

Allergies: Nil known

Past history: Osteopenia

Family history: Mother with late-onset Alzheimer’s disease

Social history: Widowed, lives alone, adult children interstate. Previously active in local medical network, now mostly at home.

Examination findings: Alert and oriented. Mood low, affect congruent. No psychotic features. MoCA score: 25/30

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Nikhil Sethi, a 36-year-old anaesthetist, presents to your clinic requesting a medical certificate for ‘flu’. On further questioning, he appears visibly anxious and avoids eye contact. He eventually discloses he has been taking oxycodone tablets from his hospital’s drug cupboard for several weeks to help with back pain but now feels he can’t stop. He is frightened about being discovered and losing his career. He admits to escalating use, taking tablets before and during work shifts, and says he is barely sleeping. He denies any suicidal ideation but expresses despair and shame. He has not told anyone.

Medications: Self-administered oxycodone (no prescription)

Allergies: Nil known

Past history: Back injury from sport two years ago, treated with physiotherapy

Social history: Lives with partner, no children. Non-smoker. Previously minimal alcohol intake. No previous drug use.

Examination findings: Alert but restless. Pupils small but reactive. No cognitive impairment. Mood labile.

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Sarah D’Souza, a 39-year-old GP registrar, books a double appointment with you stating she wants to ‘get on top of things’. She discloses that she was recently diagnosed with ADHD by a private psychiatrist after years of struggling with procrastination, disorganisation, and emotional dysregulation. She has been prescribed dexamphetamine but is hesitant to start it due to concerns about stigma and AHPRA implications. She also fears that disclosure might affect her Fellowship exams. She is currently managing her own script under the psychiatrist’s care but is unsure how to proceed with informing her supervisor or practice.

Medications: Dexamphetamine (not yet commenced)

Allergies: Nil known

Past history: Nil psychiatric history until recent diagnosis

Social history: Married, two young children, lives in a dual-income household. No substance use or comorbidities.

Psychiatric history: Diagnosed with adult ADHD two months ago

Examination findings: Well kempt, articulate, mildly anxious. No signs of impairment.

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Alan Fraser, a 51-year-old oncologist, attends your clinic at the request of his wife. She has become increasingly concerned about his memory lapses and disorganisation, which have worsened over the past year. Alan reports missing appointments, forgetting conversations, and struggling to recall the names of familiar medications. He laughs it off as ‘getting older’, but admits to frustration and difficulty concentrating. He continues to work full-time in a busy tertiary hospital. He denies mood changes or substance use. There is no history of head trauma or psychiatric illness.

Medications: Rosuvastatin 10 mg daily

Allergies: Nil known

Past history: Hypercholesterolaemia

Family history: Mother diagnosed with Alzheimer’s disease at 70

Social history: Married, two teenage children. No smoking, drinks 1–2 standard drinks on weekends.

Examination findings: Alert, cooperative. MoCA: 22/30 (most impaired domains: delayed recall, executive function)

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Melissa Chan, a 45-year-old general surgeon, presents for a confidential consultation. She is visibly distressed and reveals that she is currently going through a marital separation. She reports poor sleep, early morning waking, and overwhelming feelings of failure. She has started drinking 2–3 glasses of wine nightly to help her sleep and has occasionally taken temazepam from an old prescription. She denies suicidal thoughts but feels she is ‘barely holding it together’ and has considered cancelling her theatre lists. She has not told her colleagues and fears stigma or reputational harm if she does. She is not currently seeing another GP.

Medications: Temazepam 10 mg PRN (old script)

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Two teenage children, shared custody. No other drug use. Drinking daily since separation began 6 weeks ago.

Examination findings: Tearful but articulate. No thought disorder. No suicidal ideation. Appears fatigued but no psychomotor slowing or agitation.

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Tom Beattie, a 28-year-old intern, attends for a last-minute appointment, requesting a medical certificate for ‘exhaustion’. He appears pale and anxious. On gentle prompting, he admits to having panic attacks on the wards and fears he is not competent. He has begun to dread going to work and finds himself rehearsing every conversation multiple times before seeing patients. He’s been unable to sleep and has lost 5 kg over the past six weeks. He denies suicidal ideation but says, ‘I feel like I’m falling apart’. He is too afraid to speak with his term supervisor, fearing it will affect his future career. He does not have a regular GP and this is his first time disclosing these symptoms.

Medications: Nil

Allergies: Nil known

Past history: Nil significant medical or psychiatric history

Social history: Lives alone, interstate from family. No alcohol or substance use. Limited local support network.

Examination findings: Tachycardic (HR 102 bpm), anxious, visibly fatigued. No psychosis or suicidal ideation. Affect constricted.

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Rebecca Lai, a 33-year-old emergency medicine trainee, presents for review after a recent miscarriage at 10 weeks’ gestation. She had minimal time off work and has since returned to full duties, including night shifts. She describes feeling numb and detached and admits to crying most days after her shift. She has been avoiding discussing the miscarriage with colleagues and worries they may see her as emotionally unstable. She has no thoughts of suicide but says, ‘I don’t feel like myself’. She is not currently under the care of a psychologist or GP and is unsure if her reaction is normal.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Obstetric history: G1P0, spontaneous miscarriage 4 weeks ago

Social history: Married, supportive partner. No alcohol or drug use. No children.

Examination findings: Tearful during consult, flat affect, no suicidal ideation or psychosis. Appears exhausted. No signs of self-neglect.

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Steve Alden, a 58-year-old radiologist, presents for a routine health check at your clinic. During the visit, he casually mentions that he hasn’t taken a holiday in over three years and has been feeling increasingly ‘flat’. He describes a lack of enjoyment in work and social activities, reduced energy, and difficulty sleeping. He brushes off these symptoms as ‘just getting older’. He continues to work full-time and has not discussed his symptoms with anyone. He denies suicidal ideation and says he doesn’t believe in seeing psychologists. He has no regular GP and usually self-manages minor illnesses. He is seeking advice on whether he should ‘do anything about it’.

Medications: Atorvastatin 20 mg daily

Allergies: Nil known

Past history: Hyperlipidaemia

Social history: Divorced, lives alone. Adult children interstate. No alcohol or smoking. No recreational drug use.

Examination findings: Well-groomed, quiet affect. Appears tired. PHQ-9 score: 17 (moderate depression)

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Farah Youssef, a 40-year-old obstetrician, attends for a review of her recent blood pressure readings. During the consult, she mentions that she often feels her ‘heart racing’, particularly when driving to work or between caesarean sections. She describes a constant sense of being on edge and difficulty relaxing even on days off. She denies chest pain or syncope. When asked further, she admits to experiencing these symptoms for over a year but has ignored them due to her workload. She has not had time for regular medical care and is unsure whether her symptoms are related to her physical health or ‘just stress’.

Medications: Irbesartan 150 mg daily (self-initiated)

Allergies: Nil known

Past history: Gestational hypertension in both pregnancies

Social history: Married, two young children. No alcohol or smoking. Works full-time with on-call duties.

Examination findings: BP 140/86 mmHg, HR 98 bpm. Appears tense, rapid speech. ECG: Sinus tachycardia, otherwise normal. K10: 31 (very high psychological distress)

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Edward Liao, a 63-year-old retired GP, attends for review after being encouraged by his daughter, who noticed he has been increasingly withdrawn and forgetful. He reports feeling bored and isolated since retirement 18 months ago, and spends most of his time watching television. He has not maintained contact with former colleagues or patients and admits to struggling with his sense of identity since stopping work. He has unintentionally lost 6 kg in the past year and sleeps excessively. He denies suicidal thoughts but says he ‘doesn’t see the point’ of most activities anymore.

Medications: Aspirin 100 mg daily, perindopril 5 mg daily

Allergies: Nil known

Past history: Hypertension, hyperlipidaemia

Social history: Widowed. Lives alone. Two adult children interstate. Previously active in local community. No alcohol, smoking, or drug use.

Examination findings: Alert and oriented. Appears flat and disinterested. GDS (Geriatric Depression Scale) score: 11/15 (suggestive of depression)

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Olivia Grant, a 34-year-old GP registrar, presents seeking advice about her recent diagnosis of bipolar II disorder. She was diagnosed after a hypomanic episode followed by a depressive period requiring hospitalisation earlier this year. She has been stable on lamotrigine and quetiapine for three months and is currently under shared care between a psychiatrist and psychologist. She reports feeling well, adherent to her treatment, and is keen to return to work next month. She has not disclosed her diagnosis to her training program or supervisor and is unsure whether she is obliged to.

Medications: Lamotrigine 200 mg daily, quetiapine XR 300 mg nightly

Allergies: Nil known

Past history: Bipolar II disorder (diagnosed 4 months ago), otherwise well

Social history: Lives with partner. Supportive family. No substance use. No forensic history.

Psychiatric history: Single hospitalisation for depression, good engagement with ongoing care

Examination findings: Euthymic, good insight, no thought disorder. No suicidal ideation.

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Jeremy Tan, a 38-year-old emergency medicine specialist, presents following a recent incident where he was formally counselled for yelling at a junior doctor during a high-pressure trauma case. He admits he has been irritable, short-tempered, and having difficulty sleeping for months. He says he often feels ‘on edge’, has nightmares about critical incidents, and avoids socialising with colleagues. He has started drinking 3–4 glasses of wine nightly to help him sleep. He has not spoken to anyone about this and says he worries he is ‘becoming dangerous’ but doesn’t know how to stop.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Married, one child. No previous mental health issues. No recreational drug use.

Examination findings: Alert, fatigued, anxious. Hypervigilant affect. No suicidal ideation. AUDIT-C: 8 (high risk); PTSD checklist (PCL-5): 48/80

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Anna Morales, a 29-year-old Basic Physician Trainee, presents after experiencing palpitations, tremor, and gastrointestinal upset before ward rounds. She describes intense fear of public speaking, avoidance of teaching sessions, and panic when presenting to consultants. She says she has always been shy, but since entering hospital training, her anxiety has worsened to the point of daily nausea and insomnia. She denies suicidal ideation but says she dreads going to work. She has never sought help for mental health before and is unsure whether this is ‘just normal performance anxiety’.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Lives alone. Strong academic background. No alcohol, smoking, or drug use.

Examination findings: Appears anxious, normal cardiovascular and neurological examination. GAD-7 score: 16 (moderate-to-severe anxiety)

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Marcus Wright, a 49-year-old dermatologist, presents for advice after being notified that a formal complaint has been lodged against him by a patient. He appears distressed and says he has not been sleeping since the letter arrived. He feels constantly anxious, has been avoiding clinic, and has thoughts that his career is ‘over’. He reports palpitations, poor concentration, and ruminating thoughts. He denies suicidal ideation but states he feels humiliated and is considering resigning. He has no previous mental health history and no treating GP. He is not under any current restrictions but is finding it difficult to attend work.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric or significant medical history

Social history: Married, two children. No substance use.

Examination findings: Tearful, anxious, no psychotic features. HR 92 bpm. BP 134/84 mmHg. GAD-7 score: 17 (severe anxiety)

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Linda Kwong, a 41-year-old GP, presents reluctantly after pressure from her spouse. She has been arriving late to her clinic, cancelling patients at short notice, and becoming forgetful with routine tasks. She reports feeling emotionally ‘numb’ and says she has started to dread consultations. She admits to drinking half a bottle of wine most nights to relax, and recently had a near-miss incident involving prescribing the wrong medication. She has not disclosed these concerns to anyone and is fearful that seeking help might affect her registration. She says, ‘I think I’ve burned out, but I can’t stop’.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Married with two children. No recreational drug use. Recently moved to a new clinic after a practice closure.

Examination findings: Appears exhausted. Tearful during consult. No signs of psychosis or suicidality. AUDIT-C: 9 (high-risk drinking). PHQ-9: 19 (moderately severe depression)

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Helen Zhu, a 37-year-old paediatric registrar, presents for assessment after being referred by her supervisor, who is concerned about her emotional state and interpersonal conflicts on the ward. Helen is initially defensive but then becomes tearful, stating that she is constantly tired, feels unsupported, and believes her colleagues ‘don’t like her’. She reports frequent headaches, difficulty concentrating, and occasional thoughts that she is being deliberately excluded. She denies hallucinations or suicidal ideation. She says she hasn’t seen a GP in years and has never accessed mental health care, fearing judgement.

Medications: Nil

Allergies: Nil known

Past history: Nil documented psychiatric history

Social history: Single, lives alone, limited support network. No alcohol or substance use.

Examination findings: Flat affect, guarded but cooperative. Oriented. PHQ-9: 20 (severe depression). No psychosis.

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr David Nair, a 35-year-old anaesthetic registrar, presents following an incident where he fainted during a morning list. He was cleared medically in ED but is now seeking follow-up as he feels ‘burnt out’. He describes chronic fatigue, increasing anxiety, poor appetite, and disrupted sleep for over two months. He admits to skipping meals and not taking breaks at work. He recently separated from his partner and has been sleeping on a colleague’s couch. He says he’s been ‘running on adrenaline’ but now feels emotionally and physically exhausted. He has not seen a GP in over five years.

Medications: Nil

Allergies: Nil known

Past history: Nil significant history

Social history: Recently separated, temporarily homeless. No smoking or alcohol use. No family in Australia.

Examination findings: Appears thin, pale, anxious. BMI 19. HR 88 bpm. BP 110/72 mmHg. PHQ-9: 21 (severe depression)

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Claire Morris, a 44-year-old psychiatrist, presents after experiencing an episode of overwhelming panic while driving to work. She had to pull over due to shortness of breath, chest tightness, and dizziness. She was assessed in ED where cardiac causes were excluded. She reports having had several similar episodes over the past three months, usually triggered by high-stakes clinical reviews or medico-legal concerns. She is currently managing a complex forensic caseload and says she has been taking on extra responsibilities. She denies substance use and has not previously experienced mental health issues.

Medications: Nil

Allergies: Nil known

Past history: Nil significant psychiatric or medical history

Social history: Divorced, lives alone. One teenage child. Works full-time. No alcohol or smoking.

Examination findings: Anxious, tearful. HR 96 bpm. BP 128/82 mmHg. No psychosis or suicidality. GAD-7: 15 (moderate anxiety)

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Samantha Doyle, a 55-year-old general practitioner, presents following an anonymous patient complaint regarding a delayed diagnosis of melanoma. She is visibly distressed and reports feeling like a ‘failure’. She says she has been struggling with self-doubt, reduced confidence in her clinical decision-making, and increasing anxiety before patient consultations. She has started second-guessing herself and spending excessive time on notes. She denies suicidal ideation but admits to early morning waking and ruminating over past decisions. She has no regular treating GP and says this is the first time in her career she has felt like she ‘can’t cope’.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Divorced, lives alone. No alcohol or substance use. Works 4 days per week in a group practice.

Examination findings: Tearful. Anxious but cooperative. No psychotic features or suicidal ideation. PHQ-9 score: 18 (moderately severe depression)

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Nathan Bishop, a 31-year-old surgical registrar, presents at the request of his partner, who is concerned about his increasing emotional volatility. He has been yelling at home, sleeping poorly, and obsessively preparing for an upcoming Fellowship exam. He admits to drinking multiple energy drinks daily, skipping meals, and working 80+ hours per week. He denies suicidal ideation but says, ‘I feel like I’m one mistake away from everything falling apart.’ He is reluctant to engage with a GP or psychologist, stating he has no time. He has no prior mental health history and is not currently taking any medication.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Lives with partner, no children. No alcohol or drug use. High-achieving academic background.

Examination findings: Anxious, pressured speech, tremulous. BP 140/88 mmHg. HR 104 bpm. K10: 34 (very high psychological distress)

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr James Reilly, a 60-year-old rural GP, presents at the request of a colleague who noticed he has been increasingly forgetful and slow to respond in clinical handovers. James admits to occasional word-finding difficulties and difficulty recalling recent consultations. He has been practising in the same rural town for over 30 years and is well-regarded by the community. He says he’s just tired and attributes it to ageing. He has no significant psychiatric history, but has not had a formal cognitive assessment. He has no regular treating GP and has been self-managing his health.

Medications: Atorvastatin 20 mg daily

Allergies: Nil known

Past history: Hypercholesterolaemia

Family history: Father with late-onset Alzheimer’s

Social history: Lives with spouse, planning semi-retirement. No alcohol or smoking. Highly involved in local community.

Examination findings: MoCA score 23/30. Insight present but minimises symptoms. No focal neurological signs.

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Alex Houghton, a 39-year-old emergency physician, presents reluctantly after being confronted by a colleague who noticed alcohol on his breath during a morning shift. He admits to drinking heavily the night before and states that he has been using alcohol to ‘wind down’ after late shifts. He estimates drinking 6–8 standard drinks on most nights after work and has started drinking earlier in the day on his days off. He becomes visibly distressed when asked about his use, stating, ‘I never thought I’d be that doctor’. He has no past psychiatric history but has had a recent divorce and custody battle for his children.

Medications: Nil

Allergies: Nil known

Past history: Nil significant medical or psychiatric history

Social history: Divorced, two children. Lives alone. Working full-time with overnight and on-call duties.

Examination findings: Mild tremor, tachycardic (HR 102), visibly anxious. AUDIT-C: 11 (high-risk), GAD-7: 13 (moderate anxiety)

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Fiona Ellery, a 47-year-old pathologist, presents to your clinic after noticing persistent fatigue and lack of motivation over the past six months. She reports feeling emotionally flat, increasingly withdrawn, and has stopped attending departmental meetings. She attributes her symptoms to being ‘in a rut’ and says she doesn’t feel connected to her work anymore. She denies suicidal ideation but admits to thoughts of early retirement. She has not discussed this with colleagues and has no current treating GP. She is concerned that if she seeks help, it will be seen as a weakness.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Single, no children. Lives alone. No substance use. Works full-time in a hospital setting.

Examination findings: Flat affect, appears tired. No psychotic features or suicidal ideation. PHQ-9: 16 (moderate depression)

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Tara Iqbal, a 32-year-old basic physician trainee, presents requesting a certificate for stress leave. She has been experiencing daily headaches, poor sleep, and frequent crying episodes. She says she feels unsupported at work, is regularly rostered on long shifts without breaks, and fears she is not keeping up with her peers. She recently received feedback about being ‘too emotional’ during a code blue situation, which she found humiliating. She denies thoughts of self-harm but says she has considered quitting medicine. She has no regular GP and says she doesn’t want to ‘waste a psychologist’s time’.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Lives with a partner. No alcohol or recreational drug use. Limited support within the hospital system.

Examination findings: Tearful. Appears fatigued and anxious. GAD-7: 14 (moderate anxiety), PHQ-9: 15 (moderate depression)

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Matthew Kerr, a 42-year-old general surgeon, presents for assessment after noticing worsening tremor and muscle cramps over the past two months. He has also been feeling increasingly anxious and reports occasional palpitations. On further questioning, he mentions that he has been taking increasing doses of a body-building supplement obtained online, which he believes may contain anabolic steroids. He admits he started taking them to manage work stress and improve confidence after a recent weight gain. He has not discussed this with anyone and is worried about potential career consequences if the substance use is discovered.

Medications: Over-the-counter supplements (unlabelled contents)

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Lives with wife and two children. Non-smoker. No alcohol. Works full-time in private practice.

Examination findings: Fine tremor, HR 110 bpm, BP 150/90 mmHg, muscular build. Anxious but oriented. No suicidal ideation.

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Elizabeth Stone, a 57-year-old obstetrician-gynaecologist, presents for review after experiencing a transient ischaemic attack (TIA) two weeks ago. She has since returned to work part-time but reports difficulty concentrating during antenatal consults and struggles with fatigue after short shifts. She is concerned about the possibility of another episode and has started second-guessing her clinical decisions. She lives alone and has not shared her health concerns with her colleagues, fearing stigma or forced early retirement. She has no regular GP and has self-managed her blood pressure until now.

Medications: Aspirin 100 mg daily (commenced post-TIA), perindopril 5 mg daily (self-initiated)

Allergies: Nil known

Past history: Hypertension (self-managed), recent TIA

Social history: Lives alone, divorced, no children. No alcohol or drug use. Works in a busy private and public practice.

Examination findings: BP 138/86 mmHg, HR 84 bpm, neurologically intact. No cognitive impairment on MoCA (score 27/30).

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Imran Saleh, a 40-year-old GP registrar, presents for assessment after being informally reported by nursing staff for appearing distracted and disengaged during consultations. He admits to experiencing significant sleep difficulties, poor concentration, and difficulty managing time during the day. He recently moved interstate for training and says he is finding it hard to adjust. He discloses a prior diagnosis of adult ADHD but has not been under regular psychiatric care since medical school. He has been self-medicating with leftover dexamphetamine from an old prescription but is unsure how to access further support without risking his training position.

Medications: Self-administered dexamphetamine 5–10 mg intermittently

Allergies: Nil known

Past history: Adult ADHD (diagnosed age 23)

Social history: Lives alone, recently relocated. No alcohol or drug use. Minimal social support locally.

Examination findings: Alert, restless, easily distracted during interview. No psychosis. No suicidal ideation.

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Nina Patel, a 36-year-old infectious diseases physician, presents following a recent separation from her partner and multiple episodes of insomnia and emotional distress. She reports intrusive memories related to managing a difficult COVID-19 outbreak in a residential aged care facility the previous year, where several residents died. She describes nightmares, heightened startle response, and avoidance of related clinical work. She has become socially withdrawn and feels constantly on edge. She denies current suicidal ideation but feels she has ‘nothing left to give’.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Lives alone. No alcohol or substance use. Previously very engaged with work and peers.

Examination findings: Hypervigilant, anxious, tearful. No psychosis or suicidal ideation. PCL-5 score: 44/80

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Joshua Nguyen, a 30-year-old intensive care registrar, presents following an episode of chest pain and palpitations during a night shift. Cardiac investigations were normal in ED, and symptoms were attributed to anxiety. He admits to persistent insomnia, tension headaches, and a feeling of ‘dread’ before each shift. He describes a constant sense of hypervigilance and fear of making a mistake. He recently lost a patient unexpectedly and has been ruminating about the case. He says he has not told anyone and is concerned about being seen as weak in his high-performance specialty.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Lives with a partner. No alcohol, smoking, or drug use.

Examination findings: Tense, fatigued. Normal cardiovascular and neurological exam. GAD-7 score: 18 (severe anxiety)

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Alana Kaur, a 50-year-old GP, presents reluctantly after noticing increasing difficulty recalling patient details and finding words during consultations. She reports feeling ‘foggy’ and says it’s taking her longer to complete clinical notes. She attributes the symptoms to perimenopause and sleep disruption. She is still menstruating irregularly, experiences hot flushes, and reports waking multiple times per night. She says she feels embarrassed discussing this with colleagues and fears being seen as incompetent.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Married, two teenage children. No alcohol, non-smoker. Full-time clinical practice.

Examination findings: Alert, oriented, anxious affect. BP 124/78 mmHg. MoCA: 27/30. No neurological deficits.

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Oliver Brandt, a 33-year-old surgical registrar, presents after a driving offence related to speeding and narrowly avoiding a collision. He admits to chronic sleep deprivation due to long shifts, frequent on-call work, and difficulty winding down after surgery. He sleeps 3–4 hours per night on average, and has begun relying on caffeine and energy drinks to function. He reports increasing irritability and impaired concentration, and admits to nodding off briefly during a ward round. He denies substance use, depression, or suicidal ideation.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric or medical history

Social history: Single. Lives alone. No alcohol, no recreational drug use.

Examination findings: Pale, fatigued, mildly tachycardic (HR 98 bpm), otherwise normal. ESS (Epworth Sleepiness Scale): 17 (excessive daytime sleepiness)

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Melissa O’Connor, a 45-year-old hospital-based palliative care physician, presents after experiencing several weeks of emotional exhaustion and a sense of detachment from her work. She reports tearfulness during conversations with families, difficulty sleeping, and a loss of motivation. She says she dreads going into work and finds herself feeling numb or emotionally ‘shut down’ when managing patient deaths. She denies suicidal ideation but says, ‘I think I’ve reached my limit’. She has a history of high-functioning perfectionism and has not taken extended leave in several years.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Lives with partner and two children. No alcohol or drug use.

Examination findings: Appears tired, flat affect. No psychotic features. PHQ-9: 17 (moderately severe depression)

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Ben Alston, a 29-year-old emergency medicine registrar, presents after experiencing a panic attack in the hospital car park. He describes chest tightness, shortness of breath, dizziness, and a sense of impending doom. Cardiac investigations in ED were normal. He reports these episodes have become more frequent over the past two months, especially before night shifts. He has been avoiding social events, feels constantly on edge, and describes difficulty sleeping. He is embarrassed about his symptoms and fears that colleagues will perceive him as weak or unstable.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric or medical history

Social history: Lives with flatmates. Single. Minimal family support. No alcohol or recreational drug use.

Examination findings: Tremulous, anxious affect, HR 102 bpm, BP 138/84 mmHg. GAD-7: 16 (moderate-to-severe anxiety)

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Celeste Warner, a 63-year-old general practitioner, presents for a routine review. During the consultation, she shares that she is finding consultations increasingly draining and has started to forget follow-up plans she previously made with patients. She says she sometimes needs to reread her own notes to recall the clinical context. She continues to work four days a week in her long-established solo practice. She is concerned about her performance but hasn’t discussed it with anyone. She says, ‘Maybe I’m just getting old’. She has no regular treating GP and has never had a formal cognitive assessment.

Medications: Rosuvastatin 10 mg daily

Allergies: Nil known

Past history: Hyperlipidaemia

Social history: Lives with partner. No alcohol or smoking. Active lifestyle. No history of depression or substance use.

Examination findings: Alert, oriented, no focal neurological deficits. MoCA: 24/30

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Simon Fadel, a 38-year-old anaesthetist, presents for an urgent consultation at the insistence of his partner. She found several empty boxes of fentanyl patches in his study drawer and reports he has been increasingly irritable, withdrawn, and sleeping during the day. When asked directly, he admits to self-administering fentanyl patches obtained through hospital access, stating, ‘It helps me switch off after shifts’. He reports no current suicidal ideation but acknowledges feeling ashamed and unsure how to stop. He is currently rostered for on-call duties and has not disclosed his substance use to anyone at work.

Medications: Illicit fentanyl use (self-administered)

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Lives with partner. No children. Working full-time in public and private theatres. No alcohol or smoking.

Examination findings: Pupils pinpoint, mildly sedated, BP 108/68 mmHg, HR 64 bpm. Cognitively intact, cooperative.

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Priya Menon, a 34-year-old psychiatry registrar, presents for advice after experiencing increasing emotional blunting and a sense of disconnection from her patients. She says she feels emotionally ‘flat’, struggles to empathise, and worries she is no longer an effective clinician. She has recently returned to full-time work after parental leave and reports feeling overwhelmed by the demands of balancing work and family life. She denies depressive thoughts or suicidal ideation but reports fatigue, irritability, and a lack of enjoyment in both personal and professional domains. She has no current treating GP.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Married with one infant. No alcohol or drug use. Recently returned to work after 8 months of parental leave.

Examination findings: Tired appearance. Mood euthymic. Affect blunted. No psychosis or suicidal ideation. PHQ-9: 12 (moderate depression)

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Marcus Bell, a 46-year-old rural GP and practice owner, presents reporting overwhelming stress related to running his clinic. He describes increasing financial pressure, difficulty recruiting staff, and a sense of isolation. He reports daily headaches, early morning waking, and tearfulness when speaking about the practice. He says he feels ‘trapped’ and is considering selling the clinic and leaving medicine entirely. He denies suicidal ideation but expresses hopelessness and emotional exhaustion. He has no regular treating GP and has never accessed psychological support before.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Married, two children. Lives in a small town where he is the sole full-time GP.

Examination findings: Tearful, fatigued. Affect low but reactive. No psychotic features. PHQ-9: 16 (moderately severe depression)

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Amanda Yee, a 40-year-old paediatric registrar, presents for support after noticing increasing irritability, emotional lability, and difficulty concentrating during ward rounds. She has recently returned to full-time work after recovering from breast cancer treatment. She reports sleep disturbance, a sense of ‘impostor syndrome’, and fear of recurrence that intrudes on her focus. She is concerned that her performance has declined but is fearful of being seen as weak or incapable. She has not accessed any psychological support since finishing treatment and has no regular GP.

Medications: Tamoxifen 20 mg daily

Allergies: Nil known

Past history: Breast cancer (treated with surgery, chemotherapy, and radiation 12 months ago)

Social history: Lives with partner. No children. No alcohol, non-smoker.

Examination findings: Well-groomed, tearful at times. No signs of psychosis or suicidal ideation. PHQ-9: 14 (moderate depression)

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Henry Clarke, a 55-year-old solo general practitioner in a semi-rural area, presents after a complaint was made by a patient who was concerned about repeated delays in test result follow-ups. Henry admits he has been struggling to keep up with administrative tasks and feels ‘mentally slower’ than he used to be. He has been working 5½ days a week without a break for years and hasn’t had a holiday in over a decade. He denies depressive symptoms but describes physical exhaustion, difficulty focusing, and emotional numbness. He has no current treating GP.

Medications: Nil

Allergies: Nil known

Past history: Nil significant medical or psychiatric history

Social history: Divorced, lives alone. No alcohol or drug use. Strong sense of obligation to his patient community.

Examination findings: Appears tired, blunted affect. No focal neurological deficits. PHQ-9: 9 (mild depression), MoCA: 25/30

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Zoe Tran, a 28-year-old first-year intern, presents after feeling faint and overwhelmed during a resuscitation. She reports frequent nausea, poor appetite, difficulty sleeping, and pre-shift anxiety. She has started avoiding eating during the day to avoid nausea. She has lost 6 kg over the past three months and now weighs 48 kg (BMI 17.5). She admits to body dissatisfaction and feeling that she ‘has to stay in control’ as she adjusts to the pressures of hospital life. She denies self-induced vomiting or laxative use. She has no previous psychiatric history and no treating GP.

Medications: Nil

Allergies: Nil known

Past history: Nil

Social history: Lives alone. No alcohol, no recreational drug use.

Examination findings: Thin, anxious. BP 98/64 mmHg, HR 58 bpm. PHQ-9: 13 (moderate depression), EDE-Q global score: 3.9 (elevated)

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Alan Dimitriou, a 61-year-old dermatologist, presents for review after his receptionist raised concerns about him repeating patient stories and confusing follow-up dates. He has recently returned to consulting following a shoulder injury that kept him off work for two months. He says he feels ‘a bit rusty’ but attributes his forgetfulness to time away from practice. He has noticed increasing reliance on written notes and occasionally misplaces files. He has no psychiatric history, is not taking any medications, and has not seen a GP in over a year.

Medications: Nil

Allergies: Nil known

Past history: Left rotator cuff repair (2 months ago)

Social history: Lives with spouse. No alcohol or drug use. Planning semi-retirement in the next 2 years.

Examination findings: MoCA score: 24/30. No focal neurological deficits. Alert and cooperative. Mild anomia noted during conversation.

What are the most appropriate next steps in management? Select three (3) from the following list:

Dr Julia Stein, a 37-year-old obstetrics and gynaecology registrar, presents after experiencing a near miss in theatre due to delayed decision-making during a postpartum haemorrhage. She is visibly distressed and reports ongoing flashbacks, hypervigilance, and difficulty sleeping. She avoids returning to the birth suite and feels ashamed and anxious about being rostered in obstetrics again. She says she is ‘not herself’ and worries her performance has declined. She has not disclosed this to her supervisors, fearing professional consequences, and she has no treating GP or psychologist.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Lives alone. No alcohol or drug use. Recently ended a long-term relationship.

Examination findings: Anxious, restless, no psychosis. GAD-7: 17 (severe anxiety), PCL-5: 41/80

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Luke Bentley, a 44-year-old emergency physician, presents seeking advice about escalating conflict with a colleague. He reports irritability, difficulty sleeping, and episodes of emotional outbursts at work. He feels constantly under pressure and says he’s ‘on edge all the time’. He denies any previous mental health diagnosis but notes these symptoms have been worsening over six months. He has received informal feedback about being ‘abrasive’ and worries that if he takes time off, he’ll be seen as not coping. He has no regular GP and is not under the care of a psychologist.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Married, two children. No alcohol or drug use. Full-time in a metropolitan tertiary ED.

Examination findings: Tense, restless. No evidence of psychosis or suicidal ideation. PHQ-9: 13 (moderate depression), GAD-7: 14 (moderate anxiety)

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Natalie Russo, a 31-year-old hospital medical officer, presents following a recent breakup and multiple unexplained sick days. She describes feeling exhausted, worthless, and unable to concentrate. She admits to staying in bed most of the day and missing several shifts without notifying her supervisor. She reports passive suicidal thoughts but no active intent or plan. She has no prior psychiatric history and no regular GP. She feels ashamed and says, ‘I can’t believe I’ve let things get this bad’.

Medications: Nil

Allergies: Nil known

Past history: Nil psychiatric history

Social history: Lives alone. No substance use. Recently separated from long-term partner.

Examination findings: Flat affect. Tearful. No psychosis or agitation. PHQ-9: 21 (severe depression)

What are the most appropriate next steps in management? Select four (4) from the following list:

Dr Kieran Miles, a 48-year-old anaesthetist, presents following a recent motor vehicle accident in which he fell asleep at the wheel after a 16-hour shift. He was not injured, but the incident has prompted reflection on his ongoing fatigue, poor concentration, and microsleeps during theatre cases. He reports longstanding obstructive sleep apnoea (OSA) diagnosed five years ago, but he has stopped using CPAP due to discomfort. He is reluctant to take time off work due to financial obligations and fear of judgement from colleagues.

Medications: Nil

Allergies: Nil known

Past history: Obstructive sleep apnoea (diagnosed but non-compliant with CPAP)

Social history: Married, two school-aged children. No alcohol or drug use. Full-time work in public and private anaesthesia.

Examination findings: Obese (BMI 34), drowsy appearance. BP 142/88 mmHg, HR 92 bpm. Epworth Sleepiness Scale: 19 (severe daytime sleepiness)

What are the most appropriate next steps in management? Select four (4) from the following list: