May 18th-2, 2021

Question 1

3 clinical features of lithium toxicity

Answer 1

confusion
ataxia
nausea/vomiting
diarrhoea
hyperreflexia
seizure

Question 2

18/12M, dry cough for 3/52, at childcare, first child, otherwise well, 5 hx

Answer 2

• onset ?sudden for foreign body
• cough at night?
• sick contacts at home/childcare
• post-tussive vomting?
• fever?

Question 3

18/12M, dry cough for 3/52, at childcare, first child, otherwise well, 5ddx

Answer 3

• upper respiratory tract infection
• post viral cough
• pertussis
• inhaled foreign body
• post-nasal drip

Question 4

18/12M, dry cough for 3/52, at childcare, first child, otherwise well, 2mx

Answer 4

• reassurance that is self limiting, self resolve

- review in 2-3/52

Question 5

48F otherwise well, wants ovarian cancer screening, 2 advice

Answer 5

• no accepted screenig currently

- referral for familial cancer clinic for genetic screening

Question 6

48F otherwise well, wants ovarian cancer screening, 6 symptoms to watch out for

Answer 6

abdo bloating
increase in abdo girth
dyspareunia
urinary frequency
pressure/dragging sensation in abdomen
night sweats
change in bowel habits

Question 7

52M unable move face properly, can’t taste or chew, left eye closing issue, hx HTN, DM2, depression, smoker 20py, 4SD ETOH, on val/amlo 180/10, metformin XR2G, sertraline 150mg: 4ddx

Answer 7

• left sided bell’s palsy
• right sided stroke
• ramsay hunt syndrome
• parotid gland tumour

Question 8

52M unable move face properly, can’t taste or chew, left eye closing issue, hx HTN, DM2, depression, smoker 20py, 4SD ETOH, on val/amlo 180/10, metformin XR2G, sertraline 150mg, 5mx

Answer 8

• Prednisolone 1mg/kg up to 75mg max daily, PO, for 5/7
• eye patch over left eye
• valacyclovir 1G, PO, TDS for 7/7
• artificial tears for left eye
• avoid immunocompromised people as he is infectious

Question 9

76M, 18 days dry cough post-viral, lives with family, 4 month old, has post-tussive vomits, daughter cough: 3ddx

a,c,ig

Answer 9

• pertussis (can swab up to 3 weeks)
• post viral cough
• post nasal drip

Question 10

76M, 18 days dry cough post-viral, lives with family, 4 month old, has post-tussive vomits, daughter cough:4mx

Answer 10

• notify department of health
• treat all household members with azithromycin 500mg, PO daily day 1, 250mg, PO daily day 2-5
• treat patient
• treat 4month old
• keep 4 month old home from day care until 5/7 abx
• vaccinate all close contacts

Question 11

13month girl, rural, 200km away, 3/7 fever, barking cough, rhinitis, anorexia, quiet/unwell, homeopathic immunisations, temp 40, soft stridor, dx?

Answer 11

severe croup

Question 12

13month girl, rural, 200km away, 3/7 fever, barking cough, rhinitis, anorexia, quiet/unwell, homeopathic immunisations, temp 40, soft stridor, 5mx

Answer 12

• minimise handling
• O2 via mask to maintain sats above 92-94%
• nebulised adrenaline
• IM/PO dexmathasone
• organise urgent transfer for paediatric tertiary care

Question 13

13month girl, rural, 200km away, 3/7 fever, barking cough, rhinitis, anorexia, quiet/unwell, homeopathic immunisations, temp 40, soft stridor, 6 missed vacinations

Answer 13

infanrix hexa
hepatitis B
prevenar 13
MMR
nimenrix
rotavirus

Question 14

28F trisomy 21, just moved, new behaviours, 6 sources of information

K,,T,U,W,Y,x

Answer 14

• Naya herself
• accommodation staff
• previous GP
• next of kin
• case worker
• accommodation manager