2020 Flashcards
1
Q
- 5 y/o boy brought to GP with vague abdo pain. He has been having several loose bowel motions per day with occasional soiling of his underwear. His parents recall him passing a hard blood-streaked stool 5 days ago. Which is the most appropriate investigation?
a. Colonoscopy with biopsies
b. No investigations at this stage
c. Stool microscopy, culture, and sensitivity
d. Tissue transglutaminase antibody titres
e. Urgent abdominal x-ray
A
No investigations at this stage
2
Q
- 6 m/o seen in A&E is distressed and blue around the mouth. Temperature 36.5, HR 170, RR 35, O2 sats 83% on room air. He has a loud ejection systolic murmur at the upper left sternal edge. He has dropped from the 50th to the 3rd centile for weight. What is the most likely cause of the murmur?
a. Atrial septal defect
b. Innocent murmur
c. Tetralogy of Fallot
d. Transposition of the Great Vessels
e. Ventricular septal defect
A
Tetralogy of Fallot
3
Q
- 22 m/o child had cough and coryza for 2 days, and is now struggling with breathing. She has subcostal and intercostal recessions and widespread wheeze. Her temperature is 37.3, HR 125, RR 45, O2 sats 98% on room air. What is the most appropriate next step in her management?
a. 0.5L/min supplemental oxygen
b. 2 puffs beclomethasone inhaler
c. 10 puffs salbutamol inhaler
d. Intravenous aminophylline
e. Oral prednisolone
A
10 puffs salbutamol inhaler
4
Q
- 3 month old boy has 2 days of fever and crying accompanied by reduced feeding and fewer wet nappies. Temperature 38.0, HR 170, RR 38, O2 sats 97% on room air. He has reduced movement in his right leg, chest is clear, urinanalysis is normal and anterior fontanelle is slightly sunken. What is the most likely diagnosis?
a. Developmental dysplasia of the hip
b. Non-accidental injury
c. Osteomyelitis
d. Reactive arthritis
e. Sickle cell crisis
A
Osteomyelitis
5
Q
- 3 m/o boy presents in acute respiratory failure and is diagnosed with Pneumocystis pneumonia. His parents are first cousins from Pakistan. What is the most likely underlying cause?
a. Agammaglobulinaemia
b. Chronic granulomatous disease
c. Cystic fibrosis
d. HIV infection
e. Severe combined immunodeficiency
A
Severe combined immunodeficiency
6
Q
- 2 y/o girl with loud barking cough and stridor is finding it increasingly difficult to breathe. Temperature 38.3, HR 190bpm, RR 53, O2 sats 92% on room air. Which is the most appropriate immediate treatment?
a. Intravenous salbutamol
b. Intubation and ventilation
c. Nebulised adrenaline
d. Nebulised salbutamol
e. Oral dexamethasone
A
Nebulised adrenaline
7
Q
- 14 y/o girl seen in GP for short stature. The mid-parental height is on the 50th centile. She has no secondary sexual characteristics. She is not taking any medications and is otherwise well, and her progress at school is satisfactory. Which is the most likely diagnosis?
a. Constitutional delay
b. Familial short stature
c. Hypothyroidism
d. Pituitary tumour
e. Turner’s syndrome
A
Turner’s syndrome
8
Q
17. 3 week old baby referred for prolonged jaundice, dark wet nappies, and pale stools. There are no developmental concerns and he is currently breastfed. Birth weight was 3.45kg and he currently weighs 3.2kg, Temperature is 37.1, HR 140, RR 45, O2 sats 98% on room air. Investigations: Hb 110 (normal) WCC 6 (normal) Platelets 430 (slightly high) Bilirubin 175 (high) Conjugated bilirubin 100 (high) ALP 160 (normal) ALT 35 (normal) Albumin 25 (lower end of normal) Sodium 137 (normal Potassium 4 (normal) What is the most appropriate next step in management? a. Feeding advice b. Inpatient ultrasound c. I.V. antibiotics d. Outpatient ultrasound e. Phototherapy
A
Inpatient ultrasound
9
Q
- 5 y/o boy with 2 days of fever, runny nose, cough, and sore throat. He developed a rash over the past 24 hours, temperature 39.2, HR 105, RR 30, capillary refill <2 seconds and O2 sats are 98% on room air. There is cervical lymphadenopathy, a red tongue, cracked lips, and a fine erythematous macular rash all over his body. Which is the most effective treatment?
a. Aciclovir
b. Aspirin
c. Co-amoxiclav
d. Paracetamol
e. Phenoxymethylpenicillin
A
Phenoxymethylpenicillin
10
Q
- 18 m/o presents to GP with 1 day history of left ear pain. There is no discharge and mum reports normal number of wet nappies for that day. There is a bulging erythematous left tympanic membrane with no perforation. Temperature 38, HR 135, RR 33, O2 sats 98 on room air. What is the most appropriate management?
a. Offer simple analgesia and an immediate prescription of amoxicillin
b. Offer simple analgesia and ciprofloxacin ear drops
c. Offer simple analgesia and delayed prescription of amoxicillin
d. Offer simple analgesia and gentamicin ear drops
e. Offer simple analgesia and reassurance
A
Offer simple analgesia and reassurance
11
Q
- A 2 y/o in GP has worsening painful rash behind the knee for 5 days. He has eczema managed with E45 cream. Temperature 37.2, HR 130, RR 30, O2 sats 98%. What is the most appropriate management?
a. Immediate referral to Paediatric A&E
b. Give oral Aciclovir for 1 week
c. Give oral Flucloxacillin for 1 week
d. Give topical dermovate
e. Give topical fusidic acid
A
Immediate referral to Paediatric A&E
12
Q
- A 3 y/o boy in GP has left-sided neck lump on a background of 6 days of coryza, cough, and mild fever, but no systemic symptoms. Temperature 37.0, HR 105, capillary refill <1s, RR 26, O2 sats 99% on room air. ENT exam is normal and chest is clear. He has a single enlarged lymph node in the left posterior chain. What is the most appropriate next step in management?
a. Arrange urgent ENT referral
b. Arrange USS
c. Arrange urgent FBC
d. Prescribe Amoxicillin 250mg TDS for 7 days
e. Reassurance and watchful waiting
A
Reassurance and watchful waiting
13
Q
- 11 y/o girl in GP with nausea, vomiting, headaches, and loss of appetite. School say she is starting to lag behind in class and has attended the school nurse regularly with playground falls. She is a healthy weight and has no focal neurology. What is the most appropriate next step?
a. Immediately discuss with on call paediatrician
b. Reassure and review in 4 weeks
c. Refer for a non-urgent MRI brain scan
d. Refer to neurologist under 2 week wait
e. Routine bloods
A
Immediately discuss with on call paediatrician
14
Q
- 7 y/o boy in GP with bedwetting for 2 months having previously been dry at night since age 4. Abdo exam is normal. What is the most appropriate initial investigation?
a. Abdominal USS
b. Abdominal x-ray
c. Finger prick glucose test
d. Renal function
e. Urine dipstick
A
Urine dipstick
15
Q
- 35 y/o man presents to A&E agitated and requesting medication. He has mild tremor, cool and clammy skin, and goosebumps (piloerection). Ambulance staff found him in the street with an empty bottle of cider. Temperature 36.8, BP 140/100, HR 100. What is the most likely diagnosis?
a. Alcohol intoxication
b. Alcohol withdrawal syndrome
c. Opiate intoxication
d. Opiate withdrawal syndrome
e. Tricyclic antidepressant intoxication
A
Opiate withdrawal syndrome
16
Q
- 20 y/o medical student attends A&E on the eve of an exam with difficulty breathing, palpitations, and chest tightness. She says she feels close to collapse, and feels like she is going to die. This has happened before and she was prescribed Propranolol but this is no longer effective, and she has routinely declined psychological interventions. Routine blood tests, ECG, and CXR are all normal. What is the most appropriate next step in her management?
a. Diazepam
b. Fluoxetine
c. Mirtazapine
d. Risperidone
e. Venlafaxine
A
Fluoxetine
17
Q
- 21 y/o woman admitted to psych ward for an acute episode. She has been prescribed Amisulpride for the past 3 weeks and is now worries she is pregnant because she has missed her period, however her pregnancy test is negative. Which blood test should be requested in addition to routine bloods?
a. Luteinising hormone
b. Progesterone
c. Prolactin
d. Thyroid stimulating hormone
e. Triglycerides
A
Prolactin
18
Q
- 15 y/o girl has 12 months of irritable mood, lack of pleasure, poor sleep, poor concentration, and low appetite. She is struggling to concentrate at school and is getting into trouble for low marks. What is the most appropriate first-line treatment?
a. Cognitive analytic therapy
b. Cognitive behavioural therapy
c. Family therapy
d. Fluoxetine
e. Sertraline
A
Cognitive behavioural therapy
19
Q
- 32 y/o woman in first trimester of pregnancy presents with low mood, difficulty sleeping, and poor concentration at work. A trial of CBT is ineffective. What is the most appropriate next step in management?
a. Interpersonal therapy
b. Psychodynamic psychotherapy
c. Sertraline
d. Venlafaxine
e. Short course of Zopiclone
A
Sertraline
20
Q
- 51 y/o man with Down syndrome has 6 months of poor self-care, increased aggression, and personality change. Recently he has been getting lost on the walk back from the shops to his house. Temperature 36.5, HR 85, BP 127/89, and urinanalysis is negative. What is the most likely diagnosis?
a. Alzheimer’s disease
b. Delirium
c. Depression
d. Hypothyroidism
e. Psychosis
A
Alzheimer’s disease
21
Q
- 19 y/o man with 1 day of fever, muscle stiffness, palpitations, and difficulty breathing. He has a history of psychotic depression for which he has been taking Fluoxetine for 6 weeks and Risperidone for 1 week. He is agitated with temperature of 39.8, HR 114, BP 172/89, and RR 30. Chest examination is otherwise clear, and neuro exam is normal except for globally increased tone. Which investigation would be most useful diagnostically?
a. CT head
b. ECG
c. EEG
d. Lumbar puncture
e. Serum creatine kinase
A
Serum creatine kinase
22
Q
- 23 y/o man admitted for 3rd person auditory hallucinations, irritability, and beliefs that his neighbours are watching him. This is the first time he has experienced these symptoms and they have lasted for 3 weeks. What is the most likely diagnosis?
a. Acute and transient psychotic disorder
b. Adjustment disorder
c. Paranoid personality disorder
d. Schizoaffective disorder
e. Schizophrenia
A
Acute and transient psychotic disorder
23
Q
- 45 y/o man presents with worsening tremor for a few weeks. Has a history of schizophrenia in remission for which he is taking Haloperidol. There is bilateral tremor and cog-wheel rigidity in upper limbs. What is the most appropriate treatment for his symptoms?
a. Co-beneldopa
b. Entacapone
c. Pramipexole
d. Procyclidine hydrochloride
e. Selegiline hydrochloride
A
Procyclidine hydrochloride
24
Q
- 84 y/o man presents with gradual deterioration in memory for 3 years. He forgets details of conversations and to attend doctor’s appointments, though he can still manage his finances and cook and clean for himself. He regularly goes to the local shops and never gets lost. Which part of the brain is likely to be affected?
a. Cerebellum
b. Frontal lobe
c. Occipital lobe
d. Parietal lobe
e. Temporal lobe
A
Temporal lobe
25
Q
- 19 y/o woman with OCD is prescribed Sertraline at the maximum dose but it doesn’t control her symptoms. She has been unable to attend university for 4 months, and CBT has not helped in the past. What is the most appropriate next step in her management?
a. Add another antidepressant
b. Change to an antidepressant of another class
c. Refer for additional and more intensive CBT
d. Refer for deep brain stimulation
e. Refer for ECT
A
Change to an antidepressant of another class
26
Q
- 25 y/o man attends A&E with headache. He is speaking rapidly and smiling as he talks. He scratches his skin constantly and claims to feel insects crawling up him. His temperature is 36.5, HR 130, and BP 154/84. What is the most likely diagnosis?
a. Alcohol withdrawal
b. Benzodiazepine withdrawal
c. Cannabis intoxication
d. Cocaine intoxication
e. Heroin withdrawal
A
Cocaine intoxication
27
Q
- 35 y/o man brought to A&E by police who found him roaming the streets naked, propositioning women for sex. Which MHA section has been used by police to detain him?
a. Section 4
b. Section 5(2)
c. Section 5(4)
d. Section 135
e. Section 136
A
Section 136
28
Q
- A 35 y/o man with Fragile X syndrome lives alone, does voluntary work, and travels independently to familiar places, though he needs help planning travel to new areas. He attended a special needs school and has a carer supporting him by helping him to pay his bills. What is his most likely IQ?
a. 20
b. 40
c. 65
d. 80
e. 110
A
65
