2018 MCQ Flashcards
66 yo M presents to ED w/ angina pectoris. Admin med. which acts by releasing NO and his sx.s are relived. What is the most likely med?
GTN
twin-twin transfusion syndrome
Diagnosis requires 2 criteria
1. the presence of a MCDA pregnancy
2. presence of oligohydramnios (defined as a maximal vertical pocket of <2cm) in one sac AND of polyhydramnios (max. vertical pocket of >8cm) in the other sac
MCDA pregnancy
Monochorionic, diamniotic (MCDA)
- product of single fertilised egg= genetically identical twins
- share single placenta (Blood supply) but have separate amniotic sac
- Which of the following drugs is most likely to reduce mortality and morbidity in patients
with either diastolic or isolated systolic hypertension?
A. Calcium blockers
B. Thiazide-like diuretics
C. Alpha blockers
D. ACE inhibitors
E. Beta blockers
B
- note sure why answer isn’t CCB
- compared to CCBs or thiazide diuretics, ACEi/ ARBs have distinctly less efficacy in patients w/ isolated systolic HTN
Why is carbidopa used in the Tx of parkinson’s
Levodopa is converted to dopamine in the brain and peripheral tissue and replenishes the depleted striatal dopamine. It is given w/….
Carbidopa (or benserazide)= peripheral dopa decarboxylase inhibitor: To reduce the metabolism of L-Dopa in the periphery.
And therefore reduce production of dopamine in the periphery and also reduce adverse effects (e.g. nausea, vomiting, hypotension)
autograft, allograft, isograft, xenograft, technograft
Autograft: transplant to self from self
AllograftL transplant between genetically different ppl
IsograftL transplant btw genetically identical people
Xenograft: transplant btw different species
A previously well 14 month-old child, presents with a history of sudden onset of cough
and wheeze. He was playing with some toys earlier. On examination, there is evidence of
reduced air entry and wheeze over the right lung. Which of the following is the most likely
diagnosis?
A. Asthma
B. Bronchiolitis
C. Congenital airway abnormality
D. Inhaled foreign body
E. Pneumonia
D
Woman presents 10 weeks pregnant and gets a FBC, it shows a microcytic anaemia
and the blood film showed thalassemia B traits. The blood status of the partner is
unknown. What is the management?
Prevention of B thalassaemia major include:
- genetic counselling or antenatal diagnosis using fetal blood or DNA then ‘therapeutic’ abortion
28yo male with acute psychosis was admitted to the psychiatric ward for treatment for
10 days. Experienced sudden intense painful neck muscle cramping/stiffness and a
forward flexion of head. What is the drug that most likely caused his symptoms?
A. Benztropine
B. Fluoxetine
C. Haloperidol
D. Lithium
E. Olanzapine
and why
Haloperidol
- the pt has torticollis (dystonic EPSE)
-typical antipsychotics like haloperidol have more EPSEs than atypical e.g. olanzapine
what is it
pilonidal cyst (discomfort when sitting down, 23yo M)
35 y/o male feels anxious, gets tingling sensation in the lips (and other Sx) in certain
situations. He is worried to have these symptoms in front of others, therefore he avoids
crowded places. He is soon to be promoted to a higher position at work and wasn’t sure if
he could cope with it.
A. Generalised Anxiety Disorder
B. Panic Disorder
C. Social Phobia
D. Post-traumatic disorder
E. Depression
C
MoA donepezil
main therapeutic use is in alzheimer’s to increase cortical acetylcholine (acetylcholinesterase inhibitors)
30y/o lady, G2P2, comes in with 6 week old son for routine appointment. Has
symptoms of poor concentration, sleep, fatigue, loss of weight to below pre-pregnancy
weight. Vehemently denies being depressed, didn’t feel that way with first child. What is
the diagnosis?
A. Post natal depression
B. Post natal psychosis
C. Adjustment disorder
D. Baby blues
E. Persistent depressive disorder
A
23 year old married woman presents with vaginal discharge/pain. Dysuria but no
pruritus. On examination she has a raised painful inguinal lymph nodes with red ulcers on
both vulva and the cervix appears red and ulcerated. There is no malodour but profuse
clear discharge. Diagnosis?
Herpes genitalia
- genital herpes presents w/ panful genital ulcers vs primary syphilis presents w. painLESS ulcers (chancre)
7yo well, asymptomatic girl has loud pansystolic murmur, palpable thrill at left sternal
edge. Routine check. Heart sounds and apex beat otherwise normal. Diagnosis?
Ventricular septal defect (VSD)
- harsh pansystolic murmur at LSE w/ systolic thrill +/- L parasternal heave
19 yo male comes to GP very distressed. Worried about his nose, think’s it’s big and is
very conscious of it and wants to get plastic surgery because he looks at it in the mirror all
the time and he thinks the girls won’t like him because of it.
A. Body dysmorphic disorder
B. Delusional disorder
C. Micropenis
D. OCD
E. Congenital nasal hypertrophy
A
80 Year old female presents with sudden vision loss in left eye one hour ago. Over the
past week she has been having pain in her jaw when she chews. O/E she has tender,
enlarged superficial temporal arteries. What is the most appropriate immediate
management?
A. Temporal artery biopsy
B. Thombolytic therapy
C. Commence steroids
D. Cerebral angiogram
E. Urgent referral to ophthalmologist
C
GCA: start prednisolone 60mg/day PO immediately and do temporal aa bx w/in 14 days of starting steroids
20yo man brought into ED by housemates. Has rapid speech but could be interrupted.
Thought the Prime Minister was a robot sent from the future, like terminator, to kill him and
then destroy the human race. Diagnosis?
A. Mengele alogia
B. Grandiose Delusion
C. Persecutory delusion
D. Formal thought disorder
E. Projection
C
Young boy presented with sudden testicular pain. Felt nauseous and vomited.
Diagnosis?
A. Epididymitis
B. Testicular torsion
C. Hydrocoele
D. Varicocele
B
sudden onset of pain in ONE testis: makes walking uncomfortable
pain in abdo, n+v
28yo male presented with firm, non-tender intratesticular lump that is hypoechoic on
ultrasound. What do you do to confirm the diagnosis?
A. Inguinal orchiectomy
B. Trans-scrotal open biopsy
C. Trans-scrotal core biopsy
D. Fine needle aspirate
E. Serum B-HCG
why
A
when testicular cancer is suspected entire testicle is removed (orchiectomy)
testicular bx is NOT performed as a a part of evaluation due to concern that it may result in tumour seeding into the scrotal sac or mt.s into inguinal nodes
Pregnant woman completed first stage of labour in 7 hours, and second stage in 3
hours. She is well. What medication does she need now?
A. Syntocinon 10U IM
B. Syntocinon IV infusion
C. Ergometrine
syntocinon 10U IM
3rd stage of labour interventions
-The use of uterotonics are recommended for ALL births to prevent PPH (post partum haemorrhage)
-oxytocin 10IU IV/IM is recommended
35y/o female presented with a 2 year history of a slowly enlarging lump on her neck,
the mass is mobile and non tender, on the left side of her neck. She is euthyroid and
asymptomatic. Likely diagnosis is:
A. Hashimoto’s
B. Thyroid cancer
C. Simple thyroid cyst
D. Thyroid adenoma
E. Toxic multinodular goitre
simple thyroid cyst
A 30yo pregnant woman presents with premature rupture of membranes at 32 weeks.
She needs transfer to a more established hospital. In the meantime, what medications
should you give her?
vancomycin + flucloxacillin
9-month-old infant female presents distressed with proteins +++, nitrites +, leukocytes
+ on urine dipstick. She is febrile 38°C. What is the next single best step?
A. Renal USS
B. Cephalexin TDS
C. Wait until MCS to give antibiotics
D. Renal biopsy
B
30yoF BIBA after being in a fight with friends who were trying to stop her overdosing
on some medication. She has had 13 similar episodes previously. Her most notable
feature was her emotional lability. Diagnosis?
A. Borderline Personality disorder
B. Bipolar
C. Schizophrenia
D. Psychotic Depression
E. Premenstrual syndrome
A
What is the primary action of the COCP
inhibit ovulation
32yo male, Iraqi refugee who has been in Australia for 12 months. Presented to DEM
escorted by police after neighborhood disturbance. Has had four such presentations in the
last four weeks. States the Iraqi police are watching him through his TV and his body
feeling has changed. Also states insects buzzing around him so to rectify this he decided
to get rid of them via lighting ring of fire with petrol in his front yard. This is what resulted in
him being brought into ED, he had never been admitted under the psychiatry team before.
Also smokes marijuana 2-3 cones/week. Diagnosis?
A. Culture shock
B. Factitious disorder
C. Schizophrenia
D. Somatoform disorder
E. Substance abuse
C
Young female presents with copious milky discharge from her vagina. She also
noticed that there is a “foul fishy” smell. No clue cells on microscopy. Diagnosis?
A. Bacterial vaginosis
B. Candidiasis
C. Genital herpes
D. HPV
E. Chlamydia
WHY
A
bacterial vaginosis likely: thin, white d/c from vagina which is fishy smelling
candidiasis or vaginal trhush: creamy, thick (cottage cheese) d/c with no smell. Vulval irritation. Recnt Abs for sore throat.
Genital herpes: raised nodules that are painful.
Chlamydia: ost common asx
Young man feels worried about a lot of things. Seems to have no clear trigger on his
symptoms of palpitations, tremor and sweating. He is taking on a lot of responsibilities at
work however recently he has taken plenty of sick leave off work. Diagnosis?
A. Generalised Anxiety Disorder
B. Panic Disorder
C. Social Phobia
D. Post-traumatic disorder
E. Depression
A
16yo F complaints of irregular periods. Her menstrual cycle is 3-7 weeks long, and she
is concerned about her irregular bleeding. You note that she also has acne greasy skin
and a BMI of 24. What’s your management?
A. Start COCP
B. Start metformin
C. Lifestyle change
D. Start insulin
WHY
A
- address pt concern first and since it’s irregular bleeding- start COCP but ofc lifestyle changes and stuff are plausible options
Middle-aged woman presents wanting a script for the COCP. She is 6 months
postpartum, breastfeeding, has had a previous episode of DVT and suffers from migraine
without aura. Which is the absolute contraindication to COCP?
A. 6 months postpartum
B. Breastfeeding
C. Previous episode of DVT
D. Migraine without aura
previous DVT
A grandmother brings her child in. She is concerned about the injuries he sustained
when he was staying with his mother. The child appears to be on high alert. There are
some fingermark bruising on his arms and thighs. What should you do next?
A. Call child protection services
B. Call the police
C. Investigate the FBC and coagulation studies of the child
C
An infant had a difficult labour. The midwives decided to use forceps to aid delivery.
The infant then had a V-shaped bruise on forehead with image provided. Diagnosis?
forceps bruise
pregnant woman had a Caesarean section. 1 week after the operation, she
presented with offensive-smelling lochia. What is the diagnosis?
A. Endometritis
B. Wound infection
C. Retained products of conception
endometritis (lochia is vaginal d/c after birth)
young kid ate PB and has anaphylaxis- mx?
IM adrenaline
50 year old man comes into general practice for regular check-up. Asks about
screening for bowel cancer. No FHx and no symptoms. What would you suggest?
A. Colonoscopy
B. CT colonogram
C. FOBT
D. Flexible sigmoidoscopy
E. No screening required
C
Middle-aged man presents with sweating, weight loss of 6kg over past year and
tremor. Has two-year history of diffuse painless swelling at the base of neck. Examination
demonstrates mild tachycardia and fine peripheral tremor. Diagnosis?
A. Toxic multinodular goitre
B. Grave’s Disease
C. Toxic adenoma
D. Subacute thyroiditis
E. Hashimoto’s/autoimmune.
B
65 year old man presented with some shoulder pain and loss of range of abduction
(both passive and active) between 45 and 135 degrees. Movement was normal and pain
free from 0-45 and 135-180. What is the most likely pathology?
Rotator cuff pathology
what is CREST syndrome and what medication would improve peripheral circulation?
CREST
- calcinosis
-Reynaud’s
-eosophageal dymotility
-sclerodactyly
-telangiectasias (spider veins, visible small linear and red blood vessels)’
medication: nifedipine
diagnostic criteria for Kawasaki dx
fever for >5days+ at least 4 of the following:
- bilateral non-purulent conjunctivitis
- neck lymphadenopathy (>1.5cm across)
- pharyngeal injection, dry fissured lips, strawberry tongue
- polymorphous rash (especially on trunk)
- changes in extremities: arthralgia, palmar erythema or later fingertip desquamation+ swelling of hands/ feet
OCD vs OCPD
OCD: egodystonic
OCPD: (OC personality disorder or anakastic PD): egosyntonic
A 76 year-old female with known cardiomyopathy and poor left ventricular function,
presents to the Emergency Department with palpitations, dyspnoea at rest and dizziness.
Her pulse rate is 148/minute and irregularly irregular. Her ECG shows an irregularly
irregular rhythm with no P waves and normal QRS complexes. Which of the following drugs would be appropriate for long-term control of venticular rate? and why?
A. Digoxin
B. Verapamil
C. Metoprolol
D. Amiodarone
E. Adenosine
metoprolol
generally, for AF you do rhythm control for younger patients but rate control for older
A 45 year-old male presents to the Emergency Department with rapid regular
palpitations that came on while he was exercising. He is found to have a pulse rate of
148/minute and regular, with a BP of 105/60. His ECG shows a regular tachycardia with
no P waves and with normal QRS complexes. Which of the following drugs would be the
most appropriate for the acute management of this patient? and WHY
A. Digoxin
B. Verapamil
C. Metoprolol
D. Lignocaine
E. Adenosine
adenosine
- patient has supraventricular tachycardia
- adenosine is appropriate
A pregnant woman presented with rupture of membranes at 28 weeks. She was given
steroids and the baby was born 6 hours later. The neonate’s APGAR 1 minute was fine
but at 5 min, the neonate had respiratory distress. Diagnosis?
A. Hyaline membrane disease
B. Wet lung
C. Meconium aspiration
hyaline membrane dx
- pre-term babies
-given bethamethasone to try accelerate dev. of fetal lungs
-immature lungs; do not have adequate surfactant and therefore alveoli collapse
-respi distress start at or soon after delivery and get worse over the first 48 hrs
64yo male presented with right colicky loin to groin pain. Apart from fever (Temp =
38.8degC), physical examination was normal. Urinalysis revealed positive WCC and nitrites. CT showed 4mm stone and pelvic ureteric junction w/dilated ureter proximal to it. What is appropriate mx and why?
Urgent decompression
- 95% renal stones <5mm pass spontaneously by just increasing fluid intake HOWEVER, persistent infection and obstruction warrants urgent intervention.
Which of the following antibiotics is most appropriate for the treatment of a patient
infected with Shigella dysenteriae?
A. Flucloxacillin
B. Penicillin G
C. Ciprofloxacin
D. Fluconazole
E. Amoxicillin
shigella: ciprofloxacin
7yo boy presents with moderate SOB and moderate increased WOB. He has a past
history of asthma. SpO2 92% What is the initial management for the boy in the ED?
A. Nebulized SABA
B. Nebulized adrenaline
C. MDI SABA with spacer
and why
C
Guidelines recommend MDI SABA w/ spacer for mild-moderate asthma attacks. Only use nebulized salbutamol (SABA) if child is confused, exhausted w. silent chest
A child can roll over and sit with support. They can pass toys from one hand to the
other but don’t have pincer grip. They can drink from a bottle. They respond to their own
name, can babble but don’t yet have any words. They don’t have stranger anxiety.
Which option best describes the child’s developmental age:
A. 3 months
B. 6 months
C. 9 months
D. 12 months
E. 18 months
6 months
Middle-aged man presented with a small lesion on his cheek. A 1.5cm excisional
biopsy was done. How do you close the lesion up?
A. Direct closure
B. Local advancement flap
C. Free flap
D. Split skin graft
local advancement flap
A man suffered a graze from glass about 2 cm long on his cheek. What material
should be used to close this?
A. Polyglactin 00 (Vicryl)
B. 2-0 Chromic catgut suture
C. 2-0 prolene
D. 5-0 prolene
E. 10-0 prolene
and why
5-0 prolene
A monofilament non-absorbable suture is preferred for an uncomplicated laceration.
What do you do to close a wound where the edges tend to invert?
A. Continuous suture
B. Simple interrupted suture
C. Vertical mattress
D. Skin glue
vertical mattress suture
(recommended for wounds under tension and w/ edged that tend to invert)
An 8 year old girl presents with reduced hearing. When a tuning fork is placed on the
mastoid process, she is able to hear better bilaterally than when it is placed close to the
external auditory meatus. When the tuning fork is placed on her forehead, she is able to
hear it better on the left side. Diagnosis?
A. Bilateral conductive hearing loss, worse on the left side.
B. Bilateral conductive hearing loss, worse on the right side.
C. Bilateral sensorineural hearing loss, worse on the left side.
D. Sensorineural hearing loss on the right side.
E. Conductive hearing loss on the left side, sensorineural hearing loss on the right
side.
A
Middle-aged man presents with fatigue, enlarged lymph nodes and splenomegaly.
FBC reveals normal Hb, raised WCC, raised lymphocyte count, normal platelets.
A. AML
B. CML
C. CLL
D. Hodgkin’s lymphoma
E. Non-Hodgkin’s lymphoma
CLL
Ideas of reference, delusions of persecutions and auditory hallucinations are a result
of?
A. Alcohol intoxication
B. Opiate intoxication
C. Diazepam overuse
D. Amphetamine overdose
E. Heroin use
amphetamine overdose (and the sx.s may be impossible to differentiate from schizophrenia)
B and E basically the same= opiates and wrong
- Middle-aged man presents with elevated bilirubin levels but no changes in any of the
other LFT’s: GGT, AST, ALT, ALP. What is the diagnosis?
A. Alcoholic Liver Disease
B. Hepatitis
C. Gilbert’s syndrome
D. Asymptomatic Cholelithiasis
and why
Gilbert’s syndrome: common cause of unconjugated hyperbilirubinaemia due to reduce UGT-1 activity (the enzyme that conjugates bilirubin w/ glucuronic acid)
young boy presents with hearing loss, haematuria and proteinuria. He mentions that
his grandfather needed a kidney transplant too. Diagnosis?
alport syndrome
genetic, hearing loss, kidney dx and eye abnormalities
Middle-aged woman recently took esomeprazole for reflux. Her serum creatinine is now
400 with eGFR of 9 mL/min/1.73m3
acute tubulointerstitial nephritis
could aslo be AKI but apparently it’s just better to out a more specific dianosis
Middle-aged man presented with hypertension, loin pain and haematuria. Ultrasound
scan of the kidneys show a small calculi in the left ureter with multiple cysts on bilateral
kidneys
polycystic kidney dx
young boy got stung by a bee. He later presented with periorbital swelling, peripheral
oedema and proteinuria ++++
minimal change dx
47yoF with lower back pain. Has had multiple admissions in the past. Last admission
was 2 weeks ago for overdosing on IV heroin. Currently presenting with 3 day history of
worsening lower back pain. Patient is unable to sleep because of the pain. Pain is
aggravated by movement and not relived with rest. Patient has a low-grade fever. Patient
reluctant to stand for the examination because of the pain. Diffuse tenderness over lumbar
region during examination. Pain only at lower back and not anywhere else. Neurological
examination showed no abnormalities
why
vertebral osteomyelitis
pain over lumbar region, IV drug use= risk of infection, low-grade fever also indicates Ix (haematogenous spread)
- not relived by rest so unlikely to be osteoarthritis
Middle-aged lady with a pathological fracture of the vertebra. Also feeling tired. Imaging
of the spine shows multiple lytic lesions on the vertebrae.
why
multiple myeloma
Young guy with 2/12 increasing lump in posterior triangle. In the last few weeks has
become tired, night sweats and has mild cervical lymphadenopathy. Biopsy of lump shows
Reed Sternberg cells.
Hodgkin’s lymphoma
characteristic Reed-Sternberg cells (mirror-image nuclei)
32 y.o. Man presents to the Emergency department with large amounts of bright red
blood in his stools. He has a history of increasing fatigue over several weeks, bleeding
gums and pain in his back and ribs. On examination he has petechiae everywhere
AML
4yo boy who has been well comes to GP with his mum. On examination he appears
well, he is not cyanotic, but on auscultation has a soft ejection systolic murmur in
pulmonary area. There is a wide fixed splitting of S2.
why?
Atrial septal defect
- young patient
-wide splitting of s2 occurs in pulmonary stenosis but wide FIXED splitting of s2 occurs in ASD
8yo F well child presents with systolic murmur that radiates to carotids, otherwise well
aortic stenosis
A previously active 8yo presents with limping for past 2 weeks and complains of right
knee pain over last 2 weeks. Child has no memory of any trauma
juvenile idiopathic arthritis
JIA can affect knees vs slipped femoral epiphysis and Perthes dx only affects hip jt
17yo M: fever and sore hip. O/E: R thigh swollen and red
osteomyelitis (septic arhtirtis wasn’t an option)
5mnth-old F w/ bruised painful lower leg, Pt says she feel over while walking
non-accidental injury
4yo child initially developed normally and began walking. Later developed difficulty walking upstairs. Symmetrical waddling gait, O/E: neurologically intact but noticed have thick calves
Duchenne MD
22-month-old child, not walking, when she crawls she tends to drag her legs behind her. When you stand her up she stands on her toes.
Cerebral palsy
what Ix should you do?
options
● CXR & AXR
● CT
● Laparotomy
● Diagnostic Laparoscopy
● Gastroscopy
● Colonoscopy
● Abdominal Ultrasound
● No investigations required
a. 14 year old male presents with increasing central and right sided abdominal pain. O/E: 38 temp, and a hard abdomen with rebound tenderness
& guarding. He has an elevated white cell count.
b. 40yo F presents with intermittent RUQ pain, exacerbated after eating
a. diagnostic lapraoscopy
b. abdo USS
27yo M, moved Hobart from Sydney after breakup w/ partner. very paranoid re. Obama and Putin putting info inside his mind
Schizophrenia w/ thought insertions and paranoid delusions
27yo M who works in HBA. works inefficiently and starts many tasks w/o completing them. Bought a new car and some clothes in the last week. Drives to Burnie twice a week and makes it to work next morning.
manic episode
young teen girl present to ED w/ self-harm. Broke up w/ bf recently and threatened to kill herself to make him happy. Emotional liability noted.
Borderline PD
Options:
● Salmonella typhi
● Hookworm
● C. difficile
● Norovirus
● Trichuris trichiura
● Enterotoxic E.coli
● Giardia intestinalis
● Shigella
a. 40yo M Aboriginal man from remote community had occasional diarrhoea, abdo pain,
mild anaemia. Liked to walk around barefooted.
b. A medical student was travelling somewhere and had been drinking unfiltered,
untreated rain tank water for 4 weeks. He presented with 6 loose bowel motions daily for 5
weeks. He also noticed floaty, foul smelling stool.
a. Hookworm (likes to walk barefoot)
b. Giardia (floaty, foul smelling stool, unfiltered water and travel)
Elderly lady was getting pissed off and started avoiding social places. She was also
wondering why she couldn’t hear her grandchildren much anymore. She was wondering
why the young people wouldn’t speak up!
presbycusis (age-related hearing loss of both ears)
young F, URTI 2.52, now complaining of feeling fullness in ears and pain
acute suppurative OM
21 M, returned from recent diving trip in Maldives; complains of R ear pain, d/c and sensation of blocked ear
ruputred tympanic membrane
83yo F, constant diarrhoea and incontinence, has to wear pad day and night. Constipated previously
faecal impaction
23yo F, 3yr hx intermittent abdo pain, bloating and flatulence.
Colonsocopy normal. anti-tissue transglutaminase Ab negative
IBS
55yo stopped period 4years ago. Present w/ irregular PV spotting
endometrial cancer
young F, found collapsed at home and BIBA. Lower abdo pain, no period for >6 weeks
(ruptured) ectopic pregnancy
27 yo F, headaches around menstruation preceded by nausea prodrome
migraine
F, frontotemproal headache radiating to occiput accompanied by n+v, relived by dark room and rest
migraine
Young M presents to ED: pounding heart, SOB,, blurry vision, chest pain
3rd presentation this month and during prev presentations serious lung and heart conditions have been ruled out
he still insists dr.s may have missed something
panic disorder
60yo M, fullness in ear, hearing loss, n/v and dizziness >30mins
Menieres
28yo F, PHx of iritis. Now dizziness and vertical nystagmus
MS
4yo M, skin lesions 2-4mm
molluscum contagiousum
young patient 7 days hx fever, bilateral conjunctivitis, red pals and red mucosa
Kawasaki dx
pregnant lady, prev well, presented w. jt pain and widespread rash. Later had foetal demise due to hydrops fetalis
Parvovirus B19
if parvovirus B19 occurs in 1st half of pregnancy, fetus may become anaemic (virus replicates in erythroid progeniroe cells) and hydrops fetalis and miscarriage can occur
40yo M being treated for ALL woke up at night from pain in foot. Went to toilet in the dark, stubbed his toe and screamed out in pain. Went back to bed w. foot outside covers.
O/E: afebrile, red swollen 1st MTP jt tender to soft touch
acute gout
4yo M returns w. parents to Tassie after living in a commune in the NT for 2 years. SOB, clear nasal d/c >1 week. Worsened over >24hrs and now has fever, fatigue, cough, SOB, generalised rash and small white lesions covering reddened pharynx and buccal mucosa
measles
presents as an acute febrile exanthemarous illness w. Koplick spots (characteristic white lesions on buccal mucosa representing grains of salt opposite molars)
11-month-old M, 2day hx URTI sx.s
currently off food and drink, super clingy to mother, appeared alert
mild tachypnoea and tachycardia w/ reduces SPpO2 w/ mild increase WOB (subcostal and intercostal recession)
clinical findings: generalised widespread wheeze and some crackles
what is the condition and likely C.A?
respiratory syncytial virus, bronchiolitis
3yo F, unwell, febrile and then dev. inspiratory stridor and nasty-sounding barking cough
parainfluenza- croup
note: croup: barking cough vs whooping cough (bacterial): high-pitched gasp/ whooping noise
how to manage pt w/ schizophrenia experiencing psychotic sx.s despite trying 3 different antipsychotics?
clozapine
pt polyuria, polydipsia, recent LoW
recurrent bouts abdo pain w/ loose bulky pale stools
chronic pancreatitis
45yo M, polyuria, polydipsia, headaches and profuse weating. Last year had bilateral carapl tunnel release and had to have wedding ring enlarged. BP O/E: 150.100mmHg
acromegaly (excessive GH release by pituitary)
features include:
increased growth of hands, coarsening face, macroglossia, widely spaced teeth, skin darkening and oily, carpal tunnel sign 50%, HTN, signs of pituitary mass, excessive sweating
complications: DM, cardiomyopathy
G4P3, 34 weeks pregnant lady presents with some dark red PV bleeding and
constant abdominal pain. The fundus is tense on palpation
placental abruption
30yo woman, G2P1 at 28 weeks pregnant presents with painless bright red PV
bleeding. Fetal HR is 140 bpm.
placenta previa
A middle-aged man was seen by the GP, and noticed he looked darker than usual,
presented with RUQ pain and arthralgias. Genetic testing showed a C282Y mutation
haemochromatosis
Young 2yo boy has a swollen knee after a fall. His mum also says he previously had
several episodes of epistaxis (nosebleed) before. Coagulation studies showed raised APTT. The PT,
INR and Fibrinogen levels are all normal. What is the coagulation disorder?
haemophilia A
You’re assessing a 50yo lady. She appears well. You are able to understand what she
is saying however you cannot catch up because she speaks too fast.
pressured speech
70yo M, sad, insomnia, poor appetite and LoW
speaks very little only using monosyllabic words w/o many conjunctions
poverty of speech (decreased quality not rate of speech)
assessing a pt w/ schizophrenia. Can’t seem to understand him because he goes off topic easily
loosening of associations (thoughts move quickly fron one idea to the next- seem not to be connected at all. Experienced as muddles or illogical speech)
middle-aged M schizophrenia
“hemislayer” was hunting him down and lock him in the “interschizal dimension”
neologisms
assessing old M on ward. Nurse says he is able to understand what you are saying. When he tried to speak, he can’t articulate his words as they appear slurred
dysarthria
CEO comes and tells him his F coworker is crazy. Despite multiple rejections, she continues sending him flowers and love letters
erotomania/ De Clerambault’s syndrome
delusion of being secretly loved, usually by someone of higher social status/ Delusions of love are more common in F vs delusions of jealousy are more common in M
middle-aged M feels that soon he will not exist/ He visits church very regularly, and while walking on the streets, he points to ppl and says the end is near.
nihilism
middle-aged M, red painful eye and hypopyon (pus in anterior chamber), recent eye surgery
endopthalmitis
60 yo F, acute painful eye
seeing through mist, preceded by halos of light
n+v, similar less painful episodes in past
L pupil dilates and uncreative for both direct and consensual light reflexes.
R eye NAD
acute glaucoma
morphological appearance of lungs in chronic smokers
centrilobular emphysema predominantly upper lobe
morphological appearance of lungs in ppl w/ a1 antitrypsin deficiency
panlobular emphysema predominantly lower lobe
45yo M, shot close range to mid-abdo. ED BP 80/50 despite aggressive fluid resus at the scene. Bloods sent for crossmatch following massive transfusion protocol. What is your best clinical mx?
blood transfusion/ laparotomy
some argue that you need transfusion before surgery and others argue that you need surgery to stop leek before the transfusion
21yo F, 4cm mass deep to SCM, it’s directed anteriorly
branchial cyst
lobulated mass located just posterior and above angle of jaw
submandibular duct stone
firm tender 1.5cm mass posterior and below jaw
lymph node
young M, redness and swlling of a lump located centrally on neck. Dad says he has had lump since he was younger, lump moves when he sticks his tongue out
thyroglossal cyst
M, prev well, presented w. fever, jaundice, RUQ pain
ascending cholangitis (charcot’s triad)
22yo F, 2 day hx abdo pain, n, v, pain maximal over McBurney’s point
acute appendicitis
F present w/ fever, dysuria, left flank pain. Has new sexual partner since few days ago
pyelonephritis
37yo M w/ intermittent severe L flank pain w Hx of Chron’s. Urinalysis shows small amounts of Blood and leukocytes, no nitrates
renal colic
Malodourous d/c green and frothy. Vulva is sore and dypareunia.
trichomonas vaginalis
(flagellete), metronidazole is the tx
Abdo examination: mild suprapubic tenderness and PV she is tender on both fornices. She feels she has a slight temp and feels generally unwell.
PID
usual tx of chlamydia
azithromycin
