mock Flashcards
A 3 week old baby boy in presented with Jaundice to his general practitioner?
List 5 questions you would ask to explore potential causes further?
Weight gain? Colour of stools? Colour of urine? Type of feed? Feeding well / feed volumes? Fever? Pallor? Sibling with jaundice? Initial Phototherapy needed? Birth trauma / cephalohaematoma? Activity?
A 3 week old baby boy in presented with Jaundice to his general practitioner
List 3 Investigations you wish to undertake? (3)
Bilirubin (Conjugated and unconjugated), LFT, FBC, Coombs, Blood film, TF
A 3 week old baby boy in presented with Jaundice to his general practitioner
Describe 3 things you would say in response? (3)
Acknowledge bloods test in babies are upsetting to think about. Explain need to rule out potentially significant pathology given duration of symptoms. Explain standard approach taken in all babies with this presentation, discuss pain relief, allow mother not to watch if preferr
A 3 week old baby boy in presented with Jaundice to his general practitioner
State the most significant potential cause? (2
(Congenital) Biliary (1) Atresia (1)
A 3 week old baby boy in presented with Jaundice to his general practitioner
What 2 things will you say to the parents regarding next steps? (2
Needs for specialist assessment/ further investigation/ referral to paediatrics (discussing potential surgery at this stage would NOT be appropriate until a diagnosis was established)
A 3 month old baby girl is presented to A+E with fever (40o c), lethargy, poor feeding and strong smelly urine in her nappy.
List 5 components of the PEWS score that will help guide the acute level of clinical concern? (5)
Temperature, Heart rate, Respiratory rate, Saturations, AVP
A 3 month old baby girl is presented to A+E with fever (40o c), lethargy, poor feeding and strong smelly urine in her nappy.
List 3 initial investigations that you would undertake? (3)
Urine dipstix and culture, FBC, CRP, U+E, Blood culture, Throat swab, LP
A 3 month old baby girl is presented to A+E with fever (40o c), lethargy, poor feeding and strong smelly urine in her nappy.
Describe 2 things you would say in response? (2
Needs to stay in hospital, needs further investigation, potentially serious infection, oral treatment insufficient at this age, potential to get worse quickly if at home
A 3 month old baby girl is presented to A+E with fever (40o c), lethargy, poor feeding and strong smelly urine in her nappy.
What is the most likely diagnosis? (1)
UTI (Sepsis, meningitis also possible)
A 3 month old baby girl is presented to A+E with fever (40o c), lethargy, poor feeding and strong smelly urine in her nappy.
What initial treatment does she require? (2)
IV (1) Broad spectrum Antibiotics / cephalosporin (1)
A 3 month old baby girl is presented to A+E with fever (40o c), lethargy, poor feeding and strong smelly urine in her nappy.
Following recovery she is brought back for follow-up investigations f) Give one likely investigation that would be done and the rationale for doing it? (2)
Any of; Renal USS (System structure/dilatation/malformation), DMSA (renal scarring), MCUG (Vesico-Ureteric-Reflux)
A 3y old developmentally normal boy is presented to A+E with 48h of limp and difficulty walking. a) List 5 potential causes and a specific question you would ask to explore each one? (10)
- Transient synovitis/ Reactive arthritis (any recent coughs, colds, sore throats?) - Septic arthritis / Osteomyelitis (Any fever/sweating?) - HSP (Rash on legs?) - Rheumatic fever (any rash, other joints?) - Lyme disease (Any tick bites?) - Leukaemia (Bruising, pallor?) - Fracture / Trauma (Recent falls/injury?) - ?Primary bone tumour (Night pain? - duration makes this unlikely) - Not Juvenile Idiopathic Arthritis - duration too short
A 3y old developmentally normal boy is presented to A+E with 48h of limp and difficulty walking.
The next day he is mobilising well and is seen running around the ward. A throat swab sent the previous day was positive for rhino virus. All observations are normal. b) What is the likely diagnosis? (1)
Transient synovitis/ reactive arthriti
A 3y old developmentally normal boy is presented to A+E with 48h of limp and difficulty walking.
The next day he is mobilising well and is seen running around the ward. A throat swab sent the previous day was positive for rhino virus. All observations are normal.
c) What is the significance of the throat swab result? (2)
Typically causes URTIs (1) which are common triggers (1) of this presentation. Or Not necessarily the cause as no specific way to confirm timing of infection unless clear from history.
A 3y old developmentally normal boy is presented to A+E with 48h of limp and difficulty walking.
The next day he is mobilising well and is seen running around the ward. A throat swab sent the previous day was positive for rhino virus. All observations are normal.
d) What 2 bits of advice would you give to the parents on discharge? (2
Analgesia, mobilise as able, return if fever/joint pain/limp recur. No further investigation needed
A 13y old girl is presented to her GP following an episode of collapse at school. Some “jerky movements” were described during the episode. She has no fever and is now back to normal having been a bit pale after the event.
a) List 5 questions you would ask to help identify a potential diagnosis? (5)
Who witnessed the episode? - Precipitating event? Circumstances? (Missed meals, dehydration, stress etc.) - First change from normal / alerting circumstance? - Eyes: Rolling? Fixed? Vacant? - Limbs: Jerks? Duration? Tonic? Focal? Shivers? - Colour: Pale? (Before and/or after) Blue? - Responsiveness during episode - Time take to become responsive / total duration - Time taken to be back to normal - Development concerns in previous years Family history of epilepsy / seizures - Previous faints /syncope - Fever / recent illness
Q4. A 13y old girl is presented to her GP following an episode of collapse at school. Some “jerky movements” were described during the episode. She has no fever and is now back to normal having been a bit pale after the event.
b) What is the most common cause for this presentation? (2) And list 2 potential triggers? (2
Vaso-vagal (1) syncope (1), Dehydration, stress, postural change, temperature change, missed meals
Q4. A 13y old girl is presented to her GP following an episode of collapse at school. Some “jerky movements” were described during the episode. She has no fever and is now back to normal having been a bit pale after the event.
c) What is the single most appropriate investigation to request and why? (2)
ECG (Not EEG) to rule out long QT
Q4. A 13y old girl is presented to her GP following an episode of collapse at school. Some “jerky movements” were described during the episode. She has no fever and is now back to normal having been a bit pale after the event.
d) If you had been present at the time of the event what additional investigation would have been appropriate to preform and why? (2)
Finger prick Blood Sugar to rule out hypoglycaemia
Q4. A 13y old girl is presented to her GP following an episode of collapse at school. Some “jerky movements” were described during the episode. She has no fever and is now back to normal having been a bit pale after the event.
e) What 2 bits of advice would you give the parents on discharge? (2)
optimise Fluid intake, care when changing posture, return if recurs, common at this age, think about potential triggers, review breakfast and lunch choices, physical activity/leg strengthening exercises (aiding venous return
A 12 hour old girl is reviewed on the postnatal ward due to concerns about tachypnea (Rate = 80bpm). She was born at term via elective caesarian section and weighed 3.5 kg. She required initial positive pressure ventilation after delivery for 10 seconds but cried spontaneously afterwards. She has no fever and has been breastfeeding intermittently.
a) Describe the normal changes in foetal circulation that occur after delivery? (4)
Systemic vascular pressure rises, pulmonary pressure falls (and flow rises), ductus arteriosus and foramen ovale close, umbilical vein and artery close, ductus venosus closes, oxygen saturations rise.
A 12 hour old girl is reviewed on the postnatal ward due to concerns about tachypnea (Rate = 80bpm). She was born at term via elective caesarian section and weighed 3.5 kg. She required initial positive pressure ventilation after delivery for 10 seconds but cried spontaneously afterwards. She has no fever and has been breastfeeding intermittently.
b) Give 4 examination features that should be assessed for in this baby? (4
Respiratory effort (chest wall retractions), grunting, colour, heart rate, oxygen saturations, presence of peripheral pulses and heart sounds/murmurs, upper airway patency.
A 12 hour old girl is reviewed on the postnatal ward due to concerns about tachypnea (Rate = 80bpm). She was born at term via elective caesarian section and weighed 3.5 kg. She required initial positive pressure ventilation after delivery for 10 seconds but cried spontaneously afterwards. She has no fever and has been breastfeeding intermittently.
c) Identify 3 potential causes for this presentation? (3
Transient tachypnea of the newborn (TTN), sepsis (inc. GBS), pneumothorax (likely small). Not meconium aspiration (as not described at delivery, very unusual in an elective c-section). Congenital heart disease and upper airway obstruction possible. Not respiratory distress syndrome as very uncommon in term babies.
A 12 hour old girl is reviewed on the postnatal ward due to concerns about tachypnea (Rate = 80bpm). She was born at term via elective caesarian section and weighed 3.5 kg. She required initial positive pressure ventilation after delivery for 10 seconds but cried spontaneously afterwards. She has no fever and has been breastfeeding intermittently.
d) What would be the most appropriate next steps in managing this baby? (2
Admit to neonatal unit/ special care. Arrange CXR, blood gas, septic screen. Likely stop feeds, give IV fluids and IV antibiotic
A 12 hour old girl is reviewed on the postnatal ward due to concerns about tachypnea (Rate = 80bpm). She was born at term via elective caesarian section and weighed 3.5 kg. She required initial positive pressure ventilation after delivery for 10 seconds but cried spontaneously afterwards. She has no fever and has been breastfeeding intermittently.
The parents are keen for her to remain on the postnatal wards e) Describe 2 things you would say in response? (2)
Acknowledge concern. Indicate common cause for admission. Need to cover for potentially more serious causes. Potential risks of getting worse if causes not addressed. Can be self-limiting but further evaluation needed in first instance. Closer observation available in specialist unit. Offer to get senior to speak with them.
(T/F) Reiter’s syndrome: Is most common in elderly women
F
(T/F) Reiter’s syndrome: Responds promptly to antimicrobials
F
(T/F) Reiter’s syndrome: Is associated with a retinitis.
F
(T/F) Reiter’s syndrome: May follow infection with Shigella
T
(T/F) Reiter’s syndrome: Is a self-limiting illness of less < 6 weeks duration (T/F)
F
(T/F)Aminoglycoside antibiotics such as gentamicin: May be administered once daily
T
(T/F)Aminoglycoside antibiotics such as gentamicin:: Have synergistic activity with penicillins against enterococci
T
(T/F)Aminoglycoside antibiotics such as gentamicin:: Are effective in the treatment of severe pneumococcal pneumonia
F
(T/F)Aminoglycoside antibiotics such as gentamicin:: May cause loss of hearing in the elderly.
T
(T/F)Aminoglycoside antibiotics such as gentamicin: Should not be given to patients with severe renal impairment
F
Useful drugs in fungal infections are:
a) Zidovudine T/F
F
Useful drugs in fungal infections are: b)Netilmicin T/F C
F
Useful drugs in fungal infections are: c)Itraconazole
T
Useful drugs in fungal infections are: d) Nystatin T/F E e)
t
Useful drugs in fungal infections are: Amphotericin B
T
Varicella zoster virus (VZV): A May cause haemorrhagic shingles in the immuno-compromised T/F
T
B Is characterised by Varicella zoster virus (VZV): T/F: a discrete macular rash
F
B Is characterised by Varicella zoster virus (VZV): T/F: Can be followed by neuralgia
T
B Is characterised by Varicella zoster virus (VZV): T/F:D Is a cause of severe pneumonia
T
B Is characterised by Varicella zoster virus (VZV): T/F:E Is not sensitive to existing antivirals.
F
5) Pyrexia of unknown origin: T/F A Is a definition applied to any undiagnosed fever > 24 hours
F
5) Pyrexia of unknown origin: T/F B May be a feature of cranial arteritis.
T
5) Pyrexia of unknown origin: T/F : C Is most frequently caused by viral infections
F
5) Pyrexia of unknown origin: T/F
D May be a feature of miliary tuberculosis
T
5) Pyrexia of unknown origin: T/F
E May be the presenting feature of lymphoma
T
6) In malaria due to Plasmodium vivax: T/F Symptoms always develop within one month of returning from an endemic area
F
6) In malaria due to Plasmodium vivax: T/F Cerebral malaria is a recognised complication
F
6) In malaria due to Plasmodium vivax: T/F Infection is often acquired in the Indian subcontinent.
T
6) In malaria due to Plasmodium vivax: T/F Thrombocytopenia is a recognised feature.
T
6) In malaria due to Plasmodium vivax: T/F Resistance to antimalarials is common.
F
- In HIV infection: T/F A Acute seroconversion may be associated with rash and diarrhoea
T
- In HIV infection: Disease progress is associated with a decline in CD4 lymphocytes.T/F
T
- In HIV infection: Antiviral treatment is best started with a single agent. T/F
F
- In HIV infection: Symptoms always develop within five years of infection. T/F
F
- In HIV infection: Disease progresses most rapidly in patients infected through homosexual contact T/F
F
- In campylobacter enteritis T/F: A Symptoms start within 24 hours.
F
- In campylobacter enteritis T/F: B Antibiotic treatment is usually indicated.
F
- In campylobacter enteritis T/F: C Positive blood cultures are found in 10% of patients.
F
- In campylobacter enteritis T/F: D Diagnosis is confirmed by culture of the stool.
T
- In campylobacter enteritis T/F: E Guillan-Barre syndrome is a recognized complication following infection
T
- In pseudomembranous colitis: T/F: A Characteristic lesions are seen on colonoscopic biopsy
T
- In pseudomembranous colitis: T/F: Positive blood cultures for Clostridium difficile are found in 50% of patients
F
- In pseudomembranous colitis: T/F: C The diagnosis may be made by detection of Clostridium difficile toxin in the stool
T
- In pseudomembranous colitis: T/F: D A history of antibiotic consumption in the previous six weeks is usually elicited
T
- In pseudomembranous colitis: T/F: E Oral metronidazole often proves effective treatment.
T
10: Lyme disease: T/F: A Is caused by Borrelia burgdorferi
T
10: Lyme disease: B Is spread by rat fleas T/F:
F
10: Lyme disease: C May be associated with cranial nerve palsies T/F:
T
10: Lyme disease: T/F: D Does not respond to beta-lactam antibiotics
F
10: Lyme disease: T/F: E Is diagnosed on serological tests
T
A 25 year old man presents with a three week history of breathlessness and dry cough. He had lost two stones in weight during the previous six months and was found to have generalised lymphadenopathy and oral candidiasis. A chest X-ray shows bilateral peri-hilar pulmonary infiltrates
What is the most likely cause of this patient’s breathlessness and what disease underlies it?
Pneumocystis jirovecci pneumonia or PCP (formerly called Pneumocystis carinii pneumonia, hence the acronym PCP still commonly used). AIDS or HIV disease
A 25 year old man presents with a three week history of breathlessness and dry cough. He had lost two stones in weight during the previous six months and was found to have generalised lymphadenopathy and oral candidiasis. A chest X-ray shows bilateral peri-hilar pulmonary infiltrates
How might you confirm the cause of his breathlessness?
PCP confirmed by PCR of induced sputum or broncho- alveolar lavage.
A 25 year old man presents with a three week history of breathlessness and dry cough. He had lost two stones in weight during the previous six months and was found to have generalised lymphadenopathy and oral candidiasis. A chest X-ray shows bilateral peri-hilar pulmonary infiltrates
After the patient recovers from his acute illness, what can be done to prevent a recurrence?
Prophylaxis with daily co-trimoxazole or monthly inhaled pentamidine.
A 25 year old man presents with a three week history of breathlessness and dry cough. He had lost two stones in weight during the previous six months and was found to have generalised lymphadenopathy and oral candidiasis. A chest X-ray shows bilateral peri-hilar pulmonary infiltrates
What treatment can be given for the underlying disease process and how can the effect of the treatment be monitored?
Combination antiretroviral therapy (eg, reverse transcriptase inhibitors plus protease inhibitors). CD4 lymphocyte counts. Quantitative HIV viral load. Clinical response (weight, patient well-being).
A 25 year old man presents with a three week history of breathlessness and dry cough. He had lost two stones in weight during the previous six months and was found to have generalised lymphadenopathy and oral candidiasis. A chest X-ray shows bilateral peri-hilar pulmonary infiltrates
One year later the patient presents with a visual field defect. Which opportunistic infection is the most likely cause?
CMV (cytomegalovirus) retinitis
A 17 year old girl who suddenly became drowsy, fevered and is developing a petechial rash. - likely organism out of:
a) Clostridium difficile
b) Superantigen induced toxic shock syndrome
c) Septic shock
d) MRSA
e) E.coli 0157
f) Listeria monocytogenes
g) Pneumococcal meningitis
h) Strep. pyogenes
i) Meningococcal sepsis
j) Group B streptococcus
Meningococcal sepsis
A 54 year old man with Gramve bacilli seen on microscopy in 2 bottles of a blood culture, is transferred to ITU because he has gone into renal failure and is hypotensive despite adequate fluid resuscitation. - what is the cause out of?
a) Clostridium difficile
b) Superantigen induced toxic shock syndrome
c) Septic shock
d) MRSA
e) E.coli 0157
f) Listeria monocytogenes
g) Pneumococcal meningitis
h) Strep. pyogenes
i) Meningococcal sepsis
j) Group B streptococcus
c) Septic shock
A 75 year old female treated for 5 days with co-amoxiclav for a chest infection who had developed diarrhoea. likely causitive organism?
a) Clostridium difficile
b) Superantigen induced toxic shock syndrome
c) Septic shock
d) MRSA
e) E.coli 0157
f) Listeria monocytogenes
g) Pneumococcal meningitis
h) Strep. pyogenes
i) Meningococcal sepsis
j) Group B streptococcus
a) Clostridium difficile
A 19 year old student presents to his GP with a three month history of hearing a voice commenting on what he is doing and making derogatory comments about him. It has recently started telling him to do things. He has started to believe that his flatmates are against him and wish to harm him. He uses no illicit drugs.What is the most likely diagnosis?
Depression with psychotic features
Depression without psychotic features
Drug induced psychosis
Mania
Schizophrenia
schizophrenia
A 24 year old man is admitted to the acute psychiatric ward with a history of psychotic symptoms and is given a diagnosis of schizophrenia.Which of the following symptoms is a first rank symptom of schizophrenia?
Apathy Confabulation Nihilistic delusion Pressure of speech Thought insertion
thought insertion
A research student wishes to conduct a project on anxiety disorders and wishes to use a standardised classification system.Which of the following is the classification system used for mental illness?
CAGE ICD-9 ICD-10 SCAN SCID
ICD-10
An 8 year old boy is referred with behavioural problems to the Child Psychiatry Department. He is always active at home and moves from task to task. He finds it difficult to concentrate to read or watch TV. He often puts himself into dangerous situations like climbing onto high roofs. His performance at school is poor where he is distractible and causes distractions to others.What is the most likely diagnosis?
Attention Deficit and Hyperactivity Disorder
Conduct disorder
Mania Schizophrenia Somnambulism
attention deficit and hyperactivity disorder
An elderly man has been admitted to hospital with acute onset disorientation, visual hallucinations and agitation. He has no psychiatric history and lives alone and requires no support.What is the most likely diagnosis?
Alzheimer's Disease Delirium Depression Lewy Body Dementia Schizophrenia
delirium
You are a GP and have diagnosed a 27 year old lady with depression. You are confident that she does not require to be treated in hospital and wish to start her on treatment.Which of the following would be appropriate first line treatment?
Benzodiazepines MAOI SNRI SSRI Tricyclic
SSRI
You are a foundation doctor in an orthopaedic ward in Inverness and a patient with a moderate learning disability is admitted to the ward. The team believe that he does not have capacity to consent to an operation.Which piece of legislation would be most appropriate to use in this circumstance?
Adult Support and Protection (Scotland) Act 2007
Adults with Incapacity (Scotland) Act 2000
Mental Capacity Act 2005
Mental Health Act 2007
Mental Health (Care and Treatment)(Scotland) Act 2003
adults with incapacity (Scotland) Act 2000
A 29 year old junior doctor is being treated for depression with CBT.Which of the following is a term used in CBT?
Interpersonal Map
Negative Automatic Thoughts
Pre-contemplation
Separation Anxiety
Thought Blocking
negative automatic thoughts
A middle aged man is admitted to hospital with gall stones. Part of the admission history is to screen for alcohol problems.Which of the following is an appropriate questionnaire to screen for alcohol problems?
BDI FAST GCS MADRS MOCA
FAST
A 43 year old man is seen in Accident & Emergency after having taken an overdose of Citalopram and Lithium.Which of the following statements is true?
Lithium has a wide therapeutic index
Lithium is not a suitable treatment for unipolar depression
‘Rebound mania’ is a risk of lithium toxicity
Serum Lithium levels should be measured every 3 months
There is no point continuing lithium if the patient does not show a response within one month
serum lithium levels should be measured every 3 months
A 45 year old man is assessed in the outpatient department. He has an intense interest in rare woods and has a very rigid timetable which he sticks to each day. He is upset that the doctor assessing him was 10 minutes late. What is the most likely diagnosis?
Autistic Spectrum Disorder
Delusional Disorder
Generalised Anxiety Disorder
Obsessive Compulsive Disorder
Paranoid Personality
autistic spectrum disorder
A 39 year old woman presents with a complaint that she is fearful that something bad may happen to her. This fear occurs where-ever she goes and she cannot describe what might happen. She also complains of pains in her chest, a tremor and sweating at times. What is the most likely diagnosis?
Bipolar Affective Disorder
Depression with psychotic features
Generalised Anxiety Disorder
Paranoid Personality Disorder
Schizophrenia
generalised anxiety disorder
A 33 year old male frequently presents to his GP practice appearing to be under the influence of a substance. He seems quite sedated, has small pupils and complains of constipation. He is also noted to Hepatitis C Virus positive. What is the most likely diagnosis?
Acute Alcohol Intoxication
Acute Cannabis Intoxication
Cocaine Dependence Syndrome
Harmful Amphetamine Use
Opiate Dependence Syndrome
opiate dependence syndrome
A 67 year old woman arranges for her daughter to be able to manage her money as her own mother developed dementia at the age of 70. Which is the most appropriate legal power to use in this situation?
Assessment Order
Guardianship Order
Place of Safety Order
Power of Attorney
Restriction Order
power of attorney
A 28 year old woman with severe depression is admitted to the acute medical assessment ward having taken an overdose. She requires treatment but tries to leave the hospital. The FY2 is the only doctor available. Which is the most appropriate legal power to use in this situation?
Compulsory Treatment Order
Emergency Detention Certificate
Place of Safety Order
Restriction Order
Short Term Detention Certificate
emergency detention certificate
A 24 year old man has recently been started on new medication by his psychiatrist. One of the side effects is an unpleasant sensation of restlessness. What is the correct term for this?
Akathisia
Anhedonia
Catatonia
Dysarthria
Dystonia
akathisia
A 28 year old man has recently started on antipsychotics. He has been told about a side effect of muscle stiffness and contraction sometimes caused by antipsychotics. What is the correct term for this?
Agraphia
Akathisia
Catatonia
Dyscalculia
Dystonia
dystonia
A 34 year old man develops depression and suffers the inability to experience pleasure but can experience other emotions. What is the correct term for this?
Alexithymia
Anergia
Anhedonia
Cyclothymia
Poverty of Thought
anhedonia
A 68 year old woman has been diagnosed with severe depression. One of the symptoms is that she believes her bowels are rotting. What is the correct term for this?
Confabulation
Grandiose Delusion
Hallucination
Ideas of Reference
Nihilistic Delusion
nihilistic delusion
A 22 year old man with no previous psychiatric illness sees a street lamp flicker and suddenly knows that he is the next Scottish ambassador to Wales. What is the correct term for this?
Confabulation
Delusional Perception
Nihilistic Delusion
Thought Broadcasting
Visual Hallucination
delusional perception
