Feb Part 1 2024 Flashcards
A 7 days old baby presented with bilious vomiting, feeding intermittently, no fever, vitals stable. What to do initially?
X-ray abdomen
An elderly female 30 yr, urine exam shows 20 WBC, and culture E. coli. But no symptoms. What to do?
Nothing
A 33 weeks pregnant lady presented with vaginal bleeding and abdominal pain, abdominal tender moderately, BP 145/90, urine dipstick with + protein, + RBC. She has a previous history of preterm labor due to preeclampsia. Which one precludes tocolysis?
Vaginal bleeding
A case of skin mass excised with clear margins of 2mm. Then biopsy returned with melanoma of 0.6mm thickness. What to do?
Further excision
A young pregnant lady in 8 weeks comes to you concerning about thrombosis risk. Her mother has a PE history, her sister also with repeated DVT history. Which one is most likely to use for screening her?
Screening for thrombophilia
32 yr old female comes to you for Mirena, she is on regular condoms, has no medical history, sometimes heavy menses of 30-35 days cycles, doesn’t want pills because of forgetfulness. Which one is true regarding Mirena?
Pregnancy rate is less than 1%
A 50 yr male with right shoulder pain for days, complaining from restriction of abduction and pain in that shoulder, partially benefited from intra-articular steroid injection before. What to recommend for him as next?
Intra-articular steroid
A 53 yr old female with breast mass, mammogram done showing dense breast tissue, ultrasound showing cystic lesion. What to do next?
FNAC
An abdominal X-ray of an elderly patient with 1 day of abdominal distension, constipation, nausea, and vomiting. History of appendectomy 20 years ago.
Sigmoid volvulus/Adhesion causing obstruction
Refugee 55 yr patient with hemoptysis, cough, fever with CXR showing upper lobe apical infiltration. Sputum culture done. What to do besides this?
CT scan
Patient with long-lasting dry cough not responding to symptomatic treatment. Asking microorganism?
Mycoplasma
Child case with fever, irritability, cough, dyspnea, crepitations on exam, CXR given with 2 lesions showing fluid level. Asking for AB?
Clindamycin + Ceftriaxone
Child case with swelling, pain in left eye, cannot open that eye, high fever. Asking for AB?
IV flucloxacillin
A 55 yr old DM female BMI 31 presented for control visit regarding her cellulitis in the left leg. Mentioned that this is her 4th cellulitis event in the same leg. Healed cellulitis, both legs with varicosities but no chronic venous insufficiency signs, but between toes there is tinea infections. Asking what is the major factor causing her problem?
Diabetes Mellitus (DM)
Child with impetigo, cephalosporin prescribed, asking school exclusion.
24 hours after starting antibiotics
A patient working as a manager in a company with delaying in work, studies postponed, and difficulties in organizing work with poor concentration. All started after an event 3 months ago. Asking what you look to support diagnosis?
Anxious and fidgeting appearance
A child patient with URTI and then symptoms of rheumatic heart disease, arthritis, murmur, fever. Asking what to do to confirm?
Next ASO titre, swab test or antigen test
Best - écho
An Anti-Streptolysin O (ASO) titre is a blood test used to measure the levels of antibodies against streptolysin O, a toxin produced by Group A Streptococcus bacteria. Here’s how it relates to rheumatic heart disease:
- Diagnosis of Recent Streptococcal Infection: ASO titres help in identifying a recent streptococcal infection, which is crucial because rheumatic heart disease often follows an untreated or inadequately treated strep throat infection.
- Supporting Diagnosis of Rheumatic Fever: Elevated ASO titres can support the diagnosis of rheumatic fever, an inflammatory disease that can develop after a streptococcal infection. Rheumatic fever can cause damage to the heart valves, leading to rheumatic heart disease.
- Assessing Risk for Rheumatic Heart Disease: By confirming a recent streptococcal infection through ASO titres, clinicians can identify individuals at risk for developing rheumatic fever and subsequent rheumatic heart disease.
In summary, ASO titres are used to detect recent streptococcal infections, supporting the diagnosis of rheumatic fever, which can lead to rheumatic heart disease if not properly treated.
18 month old child presented with tonic-clonic seizure, controlled with lorazepam, temp 39, tachycardia, confused. 3 days ago, diarrhea and vomiting preceded, investigations showing sodium 119, K 4.5, C 85, Bicarb 18. Asking what to do to confirm diagnosis?
Lumbar puncture (LP)
A long scenario about a patient on warfarin, previously for URTI receiving multiple AB treatments, now on CT abdomen a large mass like appeared in anterior abdomen.
Rectus sheath hematoma
A man with RTA, GCS 6/15, has long heavy beard, BP 100/75, RR 9, SaO2 88. Asking initial step to do?
100% O2 mask ventilation immediately
A pregnant in her last trimester presented with MVA, GCS 8/15, spontaneously breathing, SaO2 95, BP 90/60, PR 105. Asking what to do first?
Put on left lateral position and urgent cross-matching
A man with midline mass 1cm. Asking what is important to support diagnosis?
Tongue extrusion
A renal pelvis stone 2 cm. Asking management?
PCNL
A question asking a patient with an accidental finding of 2.2 cm splenic artery aneurysm. What to do?
Refer for angiography/surgery
Patient for cellulitis treated with cefazolin, then picture given after 3 days of treatment, macular drug reaction on trunk. Asking the Cefazolin stopped, which one not good for patient for future?
Just cefazolin
DM patient with sudden painless loss of vision before 3 days. Asking most probably cause?
Retinal detachment/Vitreous hemorrhage
2 years old child with umbilical hernia, irritable parents concerning what to do?
Refer to emergency if <4-5 years
Patient with poker playing (gambling). Asking about most appropriate initial treatment?
CBT
Parents concerning about their 8 year old child’s behavior. Child with isolation, not prefers to play with his peers, just playing with one peer, difficult to control in school, tantrums, normal language, normal eye contact, but in his room all dolls are parallel locating, making sudden screaming occasionally. Asking diagnosis?
Autism Spectrum Disorder
AF ECG and 80 yr old patient coming to routine control, has GFR 35, creatinine high, other investigations normal, BP 145/90, PR 88 irregular, no signs of HF, DM2 on multiple drugs (aspirin, atorvastatin, metformin). Asking what to give?
Rivaroxaban
For an 80-year-old patient with atrial fibrillation (AF), a GFR of 35, and an irregular pulse, rivaroxaban can be a suitable choice for anticoagulation. Here’s why:
Reasoning for Choosing Rivaroxaban:
- Stroke Prevention: In patients with AF, anticoagulation is essential to prevent stroke. Rivaroxaban, a direct oral anticoagulant (DOAC), is effective in reducing stroke risk in AF patients.
- Renal Function: With a GFR of 35, the patient has moderate chronic kidney disease (CKD). Rivaroxaban can be used in patients with reduced renal function, although dose adjustment is necessary for those with a GFR < 50. It is often preferred over warfarin, which requires frequent monitoring and dose adjustments.
- Convenience and Compliance: Rivaroxaban has the advantage of fixed dosing and does not require regular INR monitoring, making it more convenient for patients, especially elderly ones who may have difficulty with frequent blood tests.
- Efficacy and Safety: Studies have shown that rivaroxaban is as effective as warfarin in preventing strokes in AF patients and has a similar safety profile concerning bleeding risks.
- Drug Interactions: While the patient is on multiple medications (aspirin, atorvastatin, metformin), rivaroxaban has fewer food and drug interactions compared to warfarin, simplifying the management of multiple medications.
Clinical Considerations:
- GFR and Dosing: Adjust the rivaroxaban dose according to the patient’s renal function. For a GFR of 15-49 mL/min, the recommended dose is 15 mg once daily.
- Monitoring: Although rivaroxaban does not require routine INR monitoring, it is still important to periodically monitor renal function and assess for any signs of bleeding.
- Bleeding Risk: Consider the patient’s bleeding risk, particularly given their advanced age and concomitant use of aspirin. The benefits of stroke prevention should outweigh the risks of bleeding.
Conclusion:
Rivaroxaban is chosen for this patient due to its efficacy in preventing stroke in AF, convenience, and appropriateness for patients with moderate CKD, provided dose adjustments are made. It also offers a favorable profile in terms of drug interactions and patient compliance.
Female over 3 months develops gradual loss of superior quadrants of visual fields. Asking what is the cause?
Temporal lobe tumor
A young 34 yr female with known schizophrenia on risperidone for years, has bilateral milky nipple discharge, no visual symptoms, prolactin 1200. Asking what is the cause?
Risperidone
4 month old baby brought by parents concerning about not gaining weight well, mother noticed baby’s mouth is dusky, on exam systolic murmur heard. Asking diagnosis?
Tetralogy of Fallot
An intern discovered that a medical student reached medical records of his relative who is a patient in the ward. What should the intern do?
Tell the student not to do this again
A 40 yr male patient presented to ED with sudden severe chest pain radiating to his back, long flight history of 18 hrs. ECG normal. What to do next?
CT pulmonary angiography
24 year old young lady undergoes laparoscopic cholecystectomy, 4 days later has severe shoulder tip pain. What to do next?
Ultrasound abdomen
Rupture of membrane then immediately fetal bradycardia. Scenario of cord prolapse. Asking what to do next?
Re-place the cord
An ECG of pulmonary embolism (S1Q3T3) in 45 year old female. Asking what is the most appropriate next step?
CT angiography
A female presented with labor, slow progression, oxytocin commenced, and after a while there was deceleration on CTG, 6 cm dilatation with caput and molding, baby’s part just 1 cm above the pelvic rim. What to do next?
Stop oxytocin
Another obstetric case with ROM, meconium stained, but everything was well, no deceleration on CTG, +1 station, good contractions, good effacement with 7 cm dilation. What to do next?
Continue CTG monitoring
A diabetic patient with a history of foot ulcers, presenting with a new ulcer, fever, and increased WBC. What is the next step?
Admit for IV antibiotics
A patient with recent travel history presenting with fever, headache, and maculopapular rash. What is the likely diagnosis?
Dengue fever
An elderly patient with a history of hypertension and diabetes presenting with sudden onset of hemiplegia. What is the initial investigation?
CT scan of the head
A patient with a history of HIV presenting with progressive cognitive decline, ataxia, and urinary incontinence. What is the most likely diagnosis?
Progressive multifocal leukoencephalopathy (PML)
A 30-year-old female with fatigue, hair loss, and weight gain. What is the most likely diagnosis?
Hypothyroidism
A 60-year-old male with a history of smoking presenting with hematuria. What is the next step?
Cystoscopy
A patient presenting with acute onset of severe chest pain radiating to the back, with a history of hypertension. What is the most likely diagnosis?
Aortic dissection
A 25-year-old male presenting with a painless testicular mass. What is the next step?
Scrotal ultrasound
A child presenting with a barking cough, stridor, and fever. What is the most likely diagnosis?
Croup
A patient with a history of IV drug use presenting with fever and a new heart murmur. What is the most likely diagnosis?
Infective endocarditis
A 45-year-old female presenting with bilateral hand pain and morning stiffness lasting over an hour. What is the most likely diagnosis?
Rheumatoid arthritis
A patient presenting with sudden onset of severe headache, neck stiffness, and photophobia. What is the initial investigation?
Lumbar puncture
A 50-year-old male presenting with jaundice, pruritus, and a history of inflammatory bowel disease. What is the most likely diagnosis?
Primary sclerosing cholangitis
A patient presenting with episodic palpitations, sweating, and headache. What is the most likely diagnosis?
Pheochromocytoma
A 70-year-old male with a history of COPD presenting with increasing shortness of breath and purulent sputum. What is the next step?
Antibiotics and supportive care
A patient with a history of alcoholism presenting with confusion, ataxia, and ophthalmoplegia. What is the most likely diagnosis?
Wernicke’s encephalopathy
A child presenting with a high fever, rash, and strawberry tongue. What is the most likely diagnosis?
Kawasaki disease
A 30-year-old female with a history of systemic lupus erythematosus presenting with pleuritic chest pain and a new pericardial rub. What is the most likely diagnosis?
Lupus pericarditis
A 40-year-old male with a history of gout presenting with acute monoarthritis of the big toe. What is the next step?
Joint aspiration
A patient presenting with polyuria, polydipsia, and a fasting blood glucose of 180 mg/dL. What is the most likely diagnosis?
Diabetes mellitus
A 65-year-old female with a history of osteoporosis presenting with sudden onset of severe back pain after a minor fall. What is the most likely diagnosis?
Vertebral compression fracture
A child presenting with a fever, erythema, and swelling of the left knee. What is the next step?
Joint aspiration and culture
A patient presenting with a chronic cough, weight loss, night sweats, and hemoptysis. What is the most likely diagnosis?
Tuberculosis
A 50-year-old male with a history of hypertension presenting with sudden severe headache and vomiting. What is the initial investigation?
CT scan of the head
A young male presenting with a painless ulcer on the genitalia. What is the most likely diagnosis?
Syphilis
A patient with a history of smoking presenting with a chronic cough and a chest X-ray showing a cavitary lesion. What is the most likely diagnosis?
Lung cancer
A patient presenting with progressive difficulty in swallowing solids and liquids, regurgitation of food, and weight loss. What is the most likely diagnosis?
Achalasia
A 35-year-old female presenting with fatigue, bruising, and petechiae. What is the most likely diagnosis?
Acute leukemia
A child presenting with recurrent abdominal pain, diarrhea, and growth retardation. What is the most likely diagnosis?
Crohn’s disease
A patient presenting with a painful red eye, photophobia, and decreased vision. What is the most likely diagnosis?
Uveitis
A 60-year-old male with a history of chronic liver disease presenting with confusion and asterixis. What is the most likely diagnosis?
Hepatic encephalopathy
A patient with a history of recent travel presenting with fever, jaundice, and hemolysis. What is the most likely diagnosis?
Malaria
A young female presenting with abdominal pain, fever, and a history of unprotected sex. What is the most likely diagnosis?
Pelvic inflammatory disease
A patient presenting with a history of recurrent peptic ulcers and diarrhea. What is the most likely diagnosis?
Zollinger-Ellison syndrome
A 70-year-old female presenting with progressive memory loss, difficulty in performing daily activities, and personality changes. What is the most likely diagnosis?
Alzheimer’s disease
A patient presenting with a history of headaches, visual disturbances, and an elevated ESR. What is the most likely diagnosis?
Temporal arteritis
A patient presenting with a butterfly-shaped rash on the face, photosensitivity, and joint pain. What is the most likely diagnosis?
Systemic lupus erythematosus
A child presenting with a sore throat, fever, and a sandpaper-like rash. What is the most likely diagnosis?
Scarlet fever
A patient with a history of chronic renal failure presenting with pericarditis. What is the most likely cause?
Uremia
A young male presenting with hematuria, proteinuria, and hearing loss. What is the most likely diagnosis?
Alport syndrome
A patient presenting with fatigue, weight gain, and cold intolerance. What is the most likely diagnosis?
Hypothyroidism
A child presenting with a history of recurrent respiratory infections and failure to thrive. What is the most likely diagnosis?
Cystic fibrosis
A patient presenting with sudden onset of severe epigastric pain radiating to the back, nausea, and vomiting. What is the initial investigation?
Serum amylase and lipase
A patient with a history of IV drug use presenting with jaundice, ascites, and encephalopathy. What is the most likely diagnosis?
Hepatitis C
A patient presenting with acute onset of visual loss in one eye, pain on eye movement, and a history of multiple sclerosis. What is the most likely diagnosis?
Optic neuritis
patient presenting with a painless, firm mass in the neck, night sweats, and weight loss. What is the most likely diagnosis?
Hodgkin’s lymphoma
A 55-year-old male with a history of chronic smoking presenting with a new onset of hoarseness. What is the most likely diagnosis?
Laryngeal cancer
A child presenting with a fever, headache, and a rash that starts on the wrists and ankles and spreads centrally. What is the most likely diagnosis?
Rocky Mountain spotted fever
A patient presenting with acute onset of dyspnea, pleuritic chest pain, and hemoptysis. What is the initial investigation?
CT pulmonary angiography
A young female presenting with recurrent episodes of jaundice, anemia, and splenomegaly. What is the most likely diagnosis?
Hereditary spherocytosis
A patient presenting with polyuria, polydipsia, and a blood glucose of 600 mg/dL, with ketones in urine. What is the most likely diagnosis?
Diabetic ketoacidosis
A 65-year-old male with a history of alcohol abuse presenting with confusion, ataxia, and ophthalmoplegia. What is the initial treatment?
Thiamine
A child presenting with a barking cough, stridor, and respiratory distress. What is the initial management?
Dexamethasone and nebulized epinephrine
A patient presenting with fever, chills, and right upper quadrant pain. What is the most likely diagnosis?
Acute cholecystitis
A 40-year-old female presenting with heat intolerance, palpitations, and weight loss. What is the most likely diagnosis?
Hyperthyroidism
A patient presenting with a chronic productive cough, hemoptysis, and weight loss. What is the most likely diagnosis?
Tuberculosis
A patient with a history of chronic alcoholism presenting with hematemesis and melena. What is the most likely diagnosis?
Esophageal varices
A child presenting with fever, irritability, and a bulging fontanelle. What is the most likely diagnosis?
Meningitis
A patient presenting with palpitations, sweating, and a sense of impending doom. What is the most likely diagnosis?
Panic attack
A 30-year-old male presenting with low back pain, morning stiffness, and improvement with exercise. What is the most likely diagnosis?
Ankylosing spondylitis
A patient presenting with a severe headache, photophobia, and neck stiffness. What is the most likely diagnosis?
Meningitis
A 65-year-old female with a history of diabetes presenting with new onset of vision loss in one eye. What is the most likely diagnosis?
Diabetic retinopathy
A child presenting with a high fever, sore throat, and a grayish membrane on the tonsils. What is the most likely diagnosis?
Diphtheria
A patient presenting with fatigue, petechiae, and a low platelet count. What is the most likely diagnosis?
Idiopathic thrombocytopenic purpura (ITP)
A 70-year-old male presenting with urinary urgency, frequency, and hesitancy. What is the most likely diagnosis?
Benign prostatic hyperplasia
A patient presenting with a sudden severe headache described as “the worst headache of my life.” What is the most likely diagnosis?
Subarachnoid hemorrhage
A child presenting with a low-grade fever, rash on the cheeks (“slapped cheek” appearance), and a lace-like rash on the body. What is the most likely diagnosis?
Fifth disease (erythema infectiosum)
A patient presenting with shortness of breath, elevated JVP, hypotension, and muffled heart sounds. What is the most likely diagnosis?
Cardiac tamponade
A young male presenting with hematuria, proteinuria, and a history of a recent upper respiratory infection. What is the most likely diagnosis?
IgA nephropathy (Berger’s disease)
A 50-year-old male presenting with severe epigastric pain, nausea, and vomiting after a heavy meal and alcohol consumption. What is the most likely diagnosis?
Acute pancreatitis
A patient presenting with fever, night sweats, weight loss, and lymphadenopathy. What is the most likely diagnosis?
Lymphoma
A 45-year-old female presenting with dry eyes, dry mouth, and arthritis. What is the most likely diagnosis?
Sjögren’s syndrome
A patient presenting with progressive dyspnea, cough, and a history of working in shipyards. What is the most likely diagnosis?
Asbestosis
A child presenting with fever, irritability, and a vesicular rash in various stages of healing. What is the most likely diagnosis?
Varicella (chickenpox)
A patient presenting with episodic vertigo, tinnitus, and hearing loss. What is the most likely diagnosis?
Meniere’s disease
A 60-year-old female presenting with difficulty in swallowing, regurgitation, and weight loss. What is the most likely diagnosis?
Esophageal cancer
A patient presenting with severe abdominal pain out of proportion to physical findings and a history of atrial fibrillation. What is the most likely diagnosis?
Mesenteric ischemia
A young female presenting with a history of recurrent kidney stones, hypercalcemia, and a neck mass. What is the most likely diagnosis?
Primary hyperparathyroidism
A patient presenting with a sudden onset of chest pain, sweating, and ST-elevation on ECG. What is the most likely diagnosis?
Myocardial infarction
A child presenting with recurrent episodes of wheezing, coughing, and shortness of breath. What is the most likely diagnosis?
Asthma
A 55-year-old male presenting with a history of alcohol use, confusion, asterixis, and an elevated ammonia level. What is the most likely diagnosis?
Hepatic encephalopathy
A patient presenting with a non-healing ulcer on the lower extremity, with a history of varicose veins. What is the most likely diagnosis?
Venous stasis ulcer
A young male presenting with abdominal pain, diarrhea, and a cobblestone appearance on colonoscopy. What is the most likely diagnosis?
Crohn’s disease
A patient presenting with fatigue, pallor, and a low hemoglobin level. What is the most likely diagnosis?
Anemia
A 70-year-old male presenting with a chronic cough, sputum production, and a history of smoking. What is the most likely diagnosis?
Chronic obstructive pulmonary disease (COPD)
A child presenting with fever, abdominal pain, and a positive psoas sign. What is the most likely diagnosis?
Appendicitis
A patient presenting with fever, chills, and flank pain, with a positive urine culture. What is the most likely diagnosis?
Pyelonephritis
A 40-year-old female presenting with fatigue, weight gain, and coarse facial features. What is the most likely diagnosis?
Hypothyroidism
A patient presenting with recurrent epistaxis, telangiectasias, and a family history of similar symptoms. What is the most likely diagnosis?
Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
What is it?
- A genetic disorder causing abnormal blood vessels and frequent bleeding.
Main Features:
- Frequent Nosebleeds: Often starting in childhood.
- Red Spots: Tiny dilated blood vessels on skin and inside the mouth.
- AVMs: Abnormal connections in organs like lungs, liver, and brain.
Causes:
- Genetic: Inherited from a parent.
Symptoms:
- Frequent nosebleeds.
- Red spots on the face, lips, fingers, and inside the mouth.
- Bleeding in the stomach or intestines causing anemia.
Diagnosis:
- Family History: Checking if relatives have similar symptoms.
- Physical Exam: Looking for red spots.
- Imaging Tests: Scans to find AVMs.
- Genetic Testing: To confirm the diagnosis.
Treatment:
- Nosebleeds: Humidifiers, nasal creams, or laser treatments.
- Red Spots: Laser therapy.
- AVMs: Surgery or special procedures.
- Iron Supplements: To treat anemia.
- Regular Check-ups: To monitor for new issues.
Living with HHT:
- Manage frequent nosebleeds.
- Regular medical check-ups.
- Family testing due to genetic nature.
Summary:
HHT is a genetic condition with frequent bleeding and abnormal blood vessels. Proper care and regular monitoring can effectively manage symptoms.
A young female presenting with amenorrhea, galactorrhea, and a pituitary mass on MRI. What is the most likely diagnosis?
Prolactinoma
A patient presenting with recurrent episodes of abdominal pain, diarrhea, and a family history of similar symptoms. What is the most likely diagnosis?
Irritable bowel syndrome
A 65-year-old male presenting with difficulty initiating urination, weak stream, and nocturia. What is the most likely diagnosis?
Benign prostatic hyperplasia
A patient presenting with fever, malaise, and a red, swollen joint. What is the most likely diagnosis?
Septic arthritis
A young child presenting with a pruritic rash on the face, elbows, and knees, with a history of atopy. What is the most likely diagnosis?
Atopic dermatitis (eczema)
A patient presenting with palpitations, a feeling of skipped beats, and a history of mitral valve prolapse. What is the most likely diagnosis?
Premature ventricular contractions (PVCs)
Q7: 50-year-old lady with a 2 cm breast lump, dense breast tissue on mammogram, cystic lesion on ultrasound. Management?
FNAC (Fine Needle Aspiration Cytology).
Q8: Patient with dysphagia relieved by fluids/lying down, paraesophageal hernia, on clopidogrel post-PCI. Management?
Surgical intervention.
Q9: Cellulitis in abdomen, already on IV flucloxacillin. Next investigation?
Evaluate for Dupuytren contracture.
Q10: Treatment for Hereditary Spherocytosis?
Folic Acid.
Q11: Boy concerned about body, feels shoulders are narrow, gym-going, BDD diagnosis?
Body Dysmorphic Disorder (BDD).
Q12: 10-year-old girl with dysphagia, food sticking, mild eczema. Diagnosis?
Eosinophilic Esophagitis.
Q13: Postmenopausal woman with painless breast swelling, 2 cm on ultrasound. Next step?
FNAC (Fine Needle Aspiration Cytology).
Q14: Action if a doctor wants a relationship with a former patient?
It is unethical; breaches trust.
Q15: Bat bite management?
Rabies PEP.
Q16: What to do if a colleague smells of alcohol before shift?
Confront about drinking; report to hospital management.
Q17: Elderly patient with COPD, hypertension, confusion post-party visit. Cause?
Likely alcohol or UTI.
Q18: Patient on diazepam withholding meds, presents with palpitations/anxiety. Management?
Address diazepam use.
Q19: Lady with sudden chest pain, normal vital signs, ECG, CXR. Next step?
Consider D-dimer and possibly CTPA for pulmonary embolism.
Q20: URI not responding to antibiotics, bronchoscopy shows mucus plug (mucous plug). Treatment?
Steroid therapy.
Q21: Location of right temporal quadrantopia?
Likely involving temporal lobe.
Q22: 16-year-old girl with depressive symptoms, self-injury, no suicidal thoughts. Management?
Inform parents if suicidal thoughts present; consider voluntary admission.
Q23: Management for 7 mm kidney stone with mild hydronephrosis?
ESWL (Extracorporeal Shock Wave Lithotripsy).
Q24: Elderly patient with AF, asymptomatic, next management step?
Consider anticoagulation with rivaroxaban.
Q25: Management of withdrawal symptoms in a diazepam-dependent patient?
Consider diazepam or olanzapine for symptom control.
6-day-old infant with biliary vomiting, poor feeding, abdominal distension, next investigation?
X-ray of the abdomen
Young male with midline neck lump for three months, rubbery consistency, moves with tongue?
Likely diagnosis: Thyroglossal duct cyst
Medical student accesses patient details, next step?
Discuss the breach of confidentiality and issue a warning.
80-year-old lady with severe back pain after bending, history of colon cancer, diagnosis?
Likely diagnosis: Compression fracture
Picture of abdominal cellulitis worsening on flucloxacillin, next step?
Surgical debridement if it appears necrotizing fasciitis.
Ultrasound image of cystic breast lesion, next step?
Fine needle aspiration cytology (FNAC)
Young male with epigastric pain, endoscopy shows ulcer with irregular border, H. pylori negative?
Repeat biopsy to assess for malignancy or other pathology.
Child with dysphagia for nuggets and eczema, likely diagnosis?
Eosinophilic esophagitis
Picture of submucosal abscess with recent onset severe pain, next step?
Incision and drainage under local anesthesia
Patient with sudden onset SOB and end-stage renal failure, next investigation for PE diagnosis?
Ventilation/perfusion (V/Q) scan to evaluate for pulmonary embolism
Patient following angiography develops inguinal hematoma, next step?
Apply pressure to the site to control bleeding.
When a patient develops an inguinal hematoma following angiography, the management steps according to RACGP guidelines include:
- Initial Assessment: Evaluate the hematoma’s size and severity, and check for signs of active bleeding or hemodynamic instability.
- Compression: Apply firm, direct pressure to the site to control bleeding.
- Imaging: Use ultrasound to assess the extent of the hematoma and to rule out complications such as pseudoaneurysm or active bleeding.
- Monitoring and Support: Observe the patient closely for any progression of the hematoma, and provide supportive care as needed. Ensure the patient is stable and manage pain and discomfort appropriately.
- Referral if Necessary: If the hematoma is extensive or complications are suspected, consider referral to a specialist or hospital for further management, which may include surgical intervention.
These steps are essential for preventing further complications and ensuring proper patient care following an angiographic procedure.
For more detailed information, you can refer to the RACGP guidelines on the management of post-surgical wounds and related complications oai_citation:1,RACGP - New oral anticoagulants and perioperative management of anticoagulant/antiplatelet agents oai_citation:2,RACGP - Management of post surgical wounds.
Patient requesting re-prescription of steroid cream for frequent hand washing, key statement?
Statement indicating worsening rash despite cream application.
64-year-old male with lung cancer post-radiation, presents with inflammatory shadow, management?
Prescribe Prednisolone for suspected radiation pneumonitis.
24-year-old female with splenic artery aneurysm, 2.2cm, next step?
Consider endovascular intervention based on size and symptoms.
Picture of external thrombosed pile (hemorrhoid), management?
Hemorrhoidectomy for definitive treatment.
Intern observes medical student accessing relative’s records, next action?
Warn the intern and take appropriate disciplinary action.
18-month-old child with recurrent upper respiratory infections and enlarged tonsils, likely cause?
Recurrent tonsillitis
HIV patient with CD4 count of 150, management?
Initiate Trimethoprim-Sulfamethoxazole (TMP-SMX) prophylaxis.
Girl bitten by bat, father concerned about infection, management?
Administer Rabies Post-exposure Prophylaxis (PEP).
RA patient on MTX develops pneumonia and rash, COVID-negative, precautions?
Implement droplet and contact precautions.
Man usually takes insulin at night, admitted for surgery, how to write insulin order?
Insulin 12 units subcutaneously before surgery.
Teenage boy with abdominal pain, constipation, decreased height velocity, likely diagnosis?
Coeliac disease
Mom brings 4-month-old baby with concerns about infrequent loose stools, advice?
Assure mother that this pattern can be normal in infants who are otherwise well.
Migrant with hemoptysis, fever, weight loss, smoker, CXR shows TB-like opacities, next step?
Perform Mantoux test to assess for tuberculosis infection.
Young male with chronic cough worse at night and during activity, normal exam, likely diagnosis?
Gastroesophageal reflux disease (GERD)
Daughter brings elderly mother hoarding junk, infested with insects, diagnosis?
Likely diagnosis: Senile squalor syndrome (Diogenes syndrome)
