2021 Flashcards
A 3 week old girl has had loose stools since day 2 of life and there are now streaks of blood in the stool. The baby examies well with normal observations, normal findings on abdominal examination, but there is dry skin on the scalp and face. Which is the most likely diagnosis?
a. Coeliac disease
b. Cow’s milk protein allergy
c. Gastroenteritis
d. Intussusception
e. Lactose intolerance
Cow’s milk protein allergy
A 3 year old girl with eczema has a 2 day history of a new rash on her arms (see image). Which is the most appropriate treatment for this rash?
a. IV aciclovir
b. IV flucloxacillin
c. Topical clobetasone
d. Topical emollient
e. Topical fucidi
IV aciclovir
- An 8 year old boy in the Emergency Department has been unable to open his left eye for 1 day. Prior to this he had a cold one week ago. When examining the left eye, it is difficult to open, and he reports pain on all eye movements. The conjunctiva is injected. Which is the most appropriate next step in management?
a. Blood pressure
b. Blood tests
c. CT head
d. Lumbar puncture
e. Refer to specialist
Refer to specialist
!*** A term infant born to a diabetic mother is 4 hours old on the postnatal ward and is noted to be jittery. The capillary blood gas result is as follows: pH 7.37 (7.35 - 7.45), PCO2 5.5 kPa (4.6 - 6.4), PO2 4.9 kPa (8 - 12), glucose 2.4 mmol/L (3 - 6), lactate 2.0 mmol/L (1 - 2). Which is the most appropriate treatment for the baby in this scenario?
a. Buccal midazolam
b. Feed the baby
c. IV dextrose
d. IV lorazepam
e. Oxygen
C
low oxygen, symptomatic (C)…?
A 2 year old boy has acute onset of cough and drooling, with inspiratory upper airway noises. His vaccinations are up to date. His examination is otherwise normal. His temperature is 36.8C, pulse 120 bpm, blood pressure 100/60 mmHg, respiratory rate 26 breaths per minute and oxygen saturation 98% breathing air. Which is the most likely diagnosis?
a. Anaphylaxis
b. Croup
c. Epiglottitis
d. Inhaled foreign body
e. Laryngomalacia
Inhaled foreign body
- A 14 year old girl attends Paediatric Outpatients with ongoing headaches. These are associated with nausea and vomiting and she is missing school. They are occurring once per month and at any time of day. The headaches eventually settle after lying down in a dark room. She has tried NSAIDs, which do not help. Neurological examination is normal. Which is the most appropriate treatment?
a. Aspirin once daily
b. Metoclopramide when required
c. Nasal sumatriptan when required
d. Pizotifen when required
e. Propanolol once daily
Nasal sumatriptan when required
A 7 year old boy in General Practice has a sore throat, fever and pain on swallowing for 1 day. His temperature is 38.5C, pulse rate 110 bpm, respiratory rate 24 breaths per minute, and oxygen saturation 99% breathing air. He has bilateral tonsillar enlargement with exudate and bilateral cervical lymphadenopathy. He is talking in full sentences without using accessory muscles. Which is the most appropriate management?
a. Admit to hospital
b. Continue supportive measures
c. Prescribe amoxicillin
d. Prescribe phenoxymethylpenicillin
e. Review in 48 hours
Prescribe phenoxymethylpenicillin
A 7 year old boy in General Practice has ongoing night time bed-wetting. He is dry during the day but has never been dry at night. His mother has tried managing his fluid intake, regular toileting and a star chart for 6 months with no success. He has no past medical history and takes no regular medication. He is doing well at school and at home. Abdominal examination is unremarkable. Urinalysis: Glucose - negative Protein - negative Ketone - negative Blood - negative Nitrites - negative Leukocytes - negative Which is the most suitable management option? a. Continue star chart b. Desmopressin c. Enuresis alarm d. Imipramine e. Oxybutynin
Enuresis alarm
The father of a 3 year old is concerned about her weight. She is always hungry and has put on a lot of weight this year due to overeating. The child is short in stature, has almond-shaped eyes and a narrow forehead. Which is the most likely diagnosis?
a. Edward’s syndrome
b. Fragile X syndrome
c. Pierre-Robin syndrome
d. Prader-Willi syndrome
e. William’s syndrome
Prader-Willi syndrome
A 2 year old in General Practice has a cough. He has reached all of his developmental milestones at the right time so far. Which motor skill would this child have most recently acquired?
a. Crawling
b. Draw a circle
c. Draw a square
d. Transfers objects from one hand to the other
e. Turning one page in a book
Turning one page in a book
- **A 72 year old man has a 6 month history of low mood, poor sleep and poor appetite. His wife died 1 year ago. He complains of poor memory, forgetting to take his medication and forgetting appointment dates and neglecting to pay bills. He used to attend the community centre but no longer enjoys doing so. He feels hopeless about the future. He denies social ideation. Which is the most likely diagnosis?
a. Abnormal grief reaction
b. Adjustment disorder with depressed mood
c. Alzheimer’s disease
d. Severe depressive episode without psychotic features
e. Vascular dementia
Severe depressive episode without psychotic features
could be A but would focus more around loss?
- ** A 20 year old woman attends the outpatient clinic following concerns by her GP about her eating habits. She significantly restricts her food intake and induces vomiting when she feels that she has overeaten. She speaks a lot about food and has started baking cakes, although she does not appear to eat them. She has not had a period for over 3 months. Her BMI is 18.5 kg/m2. She appears anxious when her diet is discussed. Which presenting feature most characteristically indicates a diagnosis of anorexia nervosa?
a. Amenorrhoea
b. Anxiety when discussing food
c. BMI of 18.5 kg/m2
d. Preoccupation with food
e. Purging behaviour
Anxiety when discussing food
query
- ***A 30 year old woman with type I diabetes mellitus has developed end-stage renal failure and requires dialysis. She believes that the hospital (where she is admitted) has conspired to intentionally give her diabetes. She is therefore refusing to have dialysis and is actively attempting to leave the hospital. She is able to retain the relevant information and communicate her decision to refuse dialysis, which she justifies based on her thoughts that dialysis will cause her further harm. Blood investigations: potassium 6.7 mmol/L (3.5 - 5.3), Urea 50 mmol/L (2.5 - 7.8), creatinine 1200 micromol/L (60 - 120). Which is the most appropriate next step in regards to her management?
a. Detain the patient under Section 5(2) of the Mental Health Act and provide emergency dialysis
b. Facilitate a Mental Health Act assessment
c. Facilitate an urgent best interests assessment
d. Facilitate dialysis under common law, using sedation if required
e. Facilitate discharge and continue discussions with the patient in the community
B
1st presentation of mental health. Also she hasn’t shown she lacks capacity so MCA (C) isn’t right??
A 27 year old woman with diabetes reports not sleeping for 1 week. She has recently ended her relationship with her partner of 5 years because she believes that he is a member of the CIA and has been uncharacteristically promiscuous. She states that she hears his voice even when she is not with him in the room. Which medication combination is most appropriate in this scenario?
a. Aripiprazole and sodium valproate
b. Clozapine and lithium
c. Olanzapine and carbamazepine
d. Quetiapine and lithium
e. Risperidone and lamotrigine
Quetiapine and lithium
- **A 85 year old man in the memory clinic has concerns about being unable to recall what he ate for breakfast that morning or provide detail regarding his activities today and yesterday. He has difficulties concentrating. He has a tremor and poor balance. Which is the most appropriate initial step in his work-up?
a. Blood tests
b. CT brain
c. MoCA (Montreal Cognitive Assessment)
d. MRI brain
e. Neuropsychological testing
MoCa
query could be A??
- **A 30 year old woman attends the Urgent Treatment Centre after cutting her wrists superficially. She suffers from depression and is taking sertraline 50mg daily. Her partner walked out on her this morning. She feels distressed but her sister has offered to stay with her. She has previously cut her wrists with no threat to her life. She has no thoughts of suicide. She intends to attend her appointment with the psychiatrist tomorrow. Which is the next most appropriate step in management?
a. Arrange a Mental Health Act assessment
b. Call an ambulance
c. Call the duty psychiatrist for an urgent assessment
d. Give her the 24 hour mental health crisis number
e. Increase her dose of sertraline
D
could be C? but what would that add and not suicidal
!!!*A 24 year old paramedic is referred to see a psychiatrist by her GP. She reports that she has not been herself after attending a call last month when the patient ultimately died. She complains of low mood and difficulty falling asleep on most nights. Her appetite is not affected and she has not lost any weight. Blood test results including full blood count and thyroid function tests are unremarkable. Which is her most likely diagnosis?
a. Acute stress reaction
b. Adjustment disorder
c. Depressive episode
d. Generalised anxiety disorder
e. Post-traumatic stress disorder
adjustment?
but does have biological symptoms?
could be depressive?
or E
adjustment is more if not severe enough for other things and also minor stressors
- *A 44 year old man has a 10 year history of using crack cocaine and heroin. He uses both substances once or twice per week and often feels depressed following episodes of excessive use. He developed hepatitis C after sharing needles. He does not describe a strong desire to use these substances, but nonetheless continues to do so. Which diagnosis best describes his presentation?
a. Acute intoxication
b. Dependence
c. Depressive disorder
d. Harmful use
e. Withdrawal syndrome
Harmful use
could argue dependence
A 55 year old man attends for a routine health review. He was seen on a few occasions last year after he was made redundant from his job as an IT technician. At the time he had low mood, anhedonia, insomnia and hopelessness, which all resolved after he found a new job. Which is the most likely diagnosis?
a. Adjustment disorder
b. Bipolar affective disorder
c. Personality disorder
d. Post-traumatic stress disorder
e. Severe depressive disorder
A
- **A 33 year old woman takes omeprazole, paroxetine, aripiprazole, and zopiclone for gastro-oesophageal reflux and bipolar affective disorder. She also takes the combined oral contraceptive pill. Her annual blood test show: sodium 135 mmol/L (135 - 145), potassium 4.2 mmol/L (3.5 - 5.3), urea 5.1 mmol/L (2.5 - 7.8), creatinine 63 umol/L (60 - 120), eGFR 90 (>60) and prolactin 622 UI/L (100 - 500). Which medication is most likely responsible?
a. Aripiprazole
b. Combined oral contraceptive pill
c. Omeprazole
d. Paroxetine
e. Zopiclone
C
controversial, A is atypical but used to treat hyperprol, but what about alone? could also be paroxetine.
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://qpulse.ipp-uk.com/QPulseDocumentService/Documents.svc/documents/active/attachment?number=PF-PIP-12#:~:text=Antipsychotic%20drugs%2C%20first%20generation%20Perphenazine,Increase%20serum%20prolactin%20levels%20profoundly.
most likely C?
- A 39 year old woman has a transvaginal ultrasound scan at 6 weeks of pregnancy, in which an intrauterine gestational sac was seen. She attends the Emergency Department 2 weeks later with 2 days of heavy vaginal bleeding. A transvaginal scan shows a normal endometrium. Both ovaries appear normal. There is no adnexal mass but there is a small amount of free fluid in the Pouch of Douglas. Which is the most likely diagnosis?
a. Complete miscarriage
b. Ectopic pregnancy
c. Incomplete miscarriage
d. Molar pregnancy
e. Pregnancy of unknown viability
Complete miscarriage
!**A 38 year old woman has a total abdominal hysterectomy for dysmenorrhoea. Histology shows that there were CIN 1 changes in the cervix, which were completely excised. Which is the most appropriate follow-up?
a. Back to routine smear recall
b. Colposcopy in 6 months
c. No follow up required
d. Vault smear in 6 months
e. Vault smear in 12 months
D - seen a guideline that in hysterctomy for CIN or CIN seen, do vault smear (as no cervix)
- *A 42 year old woman is 12 weeks into her third pregnancy. She would like to have screening for Trisomy 21. Which is the most sensitive screening test?
a. Amniocentesis
b. Chorionic villous sampling
c. Non-invasive pre-natal testing (cell free DNA)
d. Nuchal translucency
e. Quadruple test
Non-invasive pre-natal testing (cell free DNA)
SCREENING
. A 35 year old woman has a severe headache 24 hours following an elective cesarean section for placenta praevia under regional anaesthesia. It is worse on sitting up and better when she is lying down. Her temperature is 37.3C, heart rate 90 bpm, blood pressure 124/64 mmHg, respiratory rate 12 breaths per minute, oxygen saturation 98% breathing room air. Which is the most likely cause of her headache?
a. Cerebral venous sinus thrombosis
b. Meningitis
c. Migraine
d. Post-dural tap headache
e. Pre-eclampsia
Post-dural tap headache
