Wrong stuff Flashcards
A 13 year old girl in the Paediatric Emergency Department has drowsiness, weight loss and tiredness over the last 10 days. Her capillary blood gas results on arrival shows:
pH 7.01 (7.35 - 7.45)
PCO2 2.9 kPa (4.6 - 6.4)
HCO3 9 mmol/L (22 - 30)
Glucose 24 mmol/L (3.0 - 6.0)
Blood ketones 6 mmol/L
Following an initial ABC assessment, bloods were taken. Her latest observations are: temperature 37C, pulse rate 118 bpm, BP 105/74 mmHg, capillary refill time 3 seconds, respiratory rate 27 breaths per minute, oxygen saturation 96% breathing air.
Rank the following subsequent management steps in order of priority with (1) being performed first and (5) being performed last
SC insulin
Repeat blood gas
Administer a fluid bolus
IV insulin
Calculate IV fluid requirement
Administer a fluid bolus 1
Calculate IV fluid requirement 2
IV insulin 3
Repeat blood gas 4
SC insulin 5
- A previously well, fully immunised, 2 year old girl, has a fever, irritability and vomiting for the last 3 days. A lumbar puncture is performed, and her CSF results are as follows:
CSF protein 0.8 g/L (0.15 - 0.45)
Glucose 0.9 mmol/L (2.2 - 2.4) (blood glucose 7 mmol/L)
Polymorphonuclear cells 95%
Mononuclear cells 5%
Rank the following causative organisms in order of likelihood with (1) being the most likely and (5) being the least likely.
Streptococcus pneumoniae
Cryptococcus
Haemophilus influenzae type B
Staphylococcus aureus
Enterovirus
Streptococcus pneumoniae 1
Haemophilus influenzae type B 2
Staphylococcus aureus 3
Cryptococcus 4
Enterovirus 5
A 2 week old baby has been recently diagnosed with trisomy 21. Rank the following cardiac defects in order of likelihood
ASD
Pulmonary atresia
Mild coarctation of the aorta
AVSD
VSD
AVSD 1
VSD 2
ASD 3
Mild coarctation of the aorta 4
Pulmonary atresia 5
A 21 year old woman in the Emergency Department states that she is going to kill herself because the voices in her head are telling her to do so. Her feelings reportedly intensified following an argument with her mother earlier in the day. She demands to be admitted to the mental health unit, saying ‘it will all be your fault when I commit suicide”. She has a history of cutting and is well known to mental health services from previous crisis presentations.
Rank the following differential diagnoses in order of likelihood, with (1) being the most likely and (5) being the least likely.
Dissocial personality disorder
Paranoid schizophrenia
Depressive episode of moderate severity
Severe depressive episode with psychotic features
Emotionally unstable personality disorder
Severe depressive episode with psychotic features 1
Emotionally unstable personality disorder 2
Depressive episode of moderate severity 3
Paranoid schizophrenia 4
Dissocial personality disorder 5
A 37 year old woman in the Emergency Department has low mood, insomnia, an inability to concentrate and hopelessness for the past 6 weeks. She recently lost her job as a corporate lawyer. She had an episode of depression at the age of 26 years, which was treated with fluoxetine for 6 months. She reports being a social drinker (average consumption is 2 glasses of wine per week).
Rank the following risk factors for depression in order of significance for this woman, with (1) being the most significant and (5) being the least significant.
Alcohol intake
Gender
Age
Previous depressive episode
Recent unemployment
Recent unemployment 1
Previous depressive episode 2
Gender 3
Age 4
Alcohol intake 5
The son of an 81 year old man in General Practice is concerned about his father. His father lives alone and has become more forgetful over the past 3 months. He has left his house without shutting the door several times and has been getting lost on the way to the shops. He has well-controlled hypertension and diet-controlled Type 2 Diabetes Mellitus.
Rank the following management steps according to the sequence in which they should be implemented with (1) being carried out first and (5) being carried out last.
Arrange joint consultation with father and son
Refer to local Memory Clinic
Perform an assessment of cognition with a cognitive assessment tool
Arrange confusion screen blood tests
Assess for acute reversible causes of confusion
Arrange joint consultation with father and son 1
Assess for acute reversible causes of confusion 2
Perform an assessment of cognition with a cognitive assessment tool 3
Arrange confusion screen blood tests 4
Refer to local Memory Clinic 5
A 24 year old woman presents with a 2 day history of worsening right-sided lower abdominal pain. She is sexually active and normally uses condoms. She has a 28 day cycle and her last period was 6 weeks ago. One day ago she had loose stools and attributed this to a bad take away. She has nausea and loss of appetite but no vomiting. Her temperature is 37.3C, pulse 96 bpm, BP 110/64 mmHg, respiratory rate 18 breaths per minute, oxygen saturation 98% breathing room air.
Urine dip: blood 1+ only
Blood test results: Hb 85 g/L (115 - 150), CRP 10 mg/L (<5)
Rank the following diagnoses in order of likelihood with (1) being the most likely and (5) being the least likely.
Appendicitis
Urinary tract infection
Pyelonephritis
Ectopic pregnancy
Ovarian cyst accident
Ectopic pregnancy 1
Ovarian cyst accident 2
Appendicitis 3
Urinary tract infection 5
Pyelonephritis 4
A 36 year old mother of three young children is not using any contraception. She had a recent unplanned pregnancy and opted for a termination. She occasionally experiences headaches and smokes five cigarettes per day. Her BMI is 30 kg/m2. She has been in a relationship for 18 months.
Rank the following contraceptive choices for this woman in order of appropriateness, with (1) being the most appropriate and (5) being the least appropriate.
Combined oral contraceptive pill
Nexplanon implant
Sterilization
Mirena IUS
Condoms
Mirena IUS 1
Nexplanon implant 2
Condoms 3
Combined oral contraceptive pill 4
Sterilization 5
- A heterosexual couple in their early 30s have been trying to conceive for more than 1 year without success. Neither has any children.
Rank the following potential causes of their infertility in order of likelihood with (1) being the most likely and (5) being the least likely.
Gamete defects
Male infertility
Uterine or peritoneal disorders
Tubal damage
Ovulatory disorders
Ovulatory disorders 1
Male infertility 2
Uterine or peritoneal disorders 3
Tubal damage 4
Gamete defects 5
- 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?
Coeliac disease
Cow’s milk protein allergy
Gastroenteritis
Intussusception
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?
IV aciclovir
IV flucloxacillin
Topical clobetasone
Topical emollient
Topical fucidin
IV aciclovir
A 7 year old boy has a history of recurrent chest infections, persistent sinusitis and has been prescribed multiple courses of antibiotics. He has bibasal crepitations and a right-sided apex beat. Which is the most likely underlying diagnosis?
Agammaglobulinaemia
Cystic fibrosis
HIV
Primary ciliary dyskinesia
Primary ciliary dyskinesia
A 3 day old baby girl is not feeding well. Her temperature is 36.7C, heart rate 180 bpm, respiratory rate 66 breaths per minute. There is a systolic murmur and femoral pulses are not palpable. Which is the most likely diagnosis?
Atrial septal defect
Coarctation of the aorta
Patent ductus arteriosus
Patent foramen ovale
Ventricular septal defect
Coarctation of the aorta
A 5 year old boy in General Practice has bright red blood when opening his bowels for 1 week. He opens his bowels every 3 days. He has no past medical history and is thriving. He has a well-balanced diet and has good fluid intake. There are no safeguarding concerns. Abdominal examination is unremarkable. Rectal inspection reveals a fissure. Which is the most appropriate management?
Dietary advice
Osmotic laxative
Phosphate enema
Stimulant laxative
Toilet training
Osmotic laxative
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?
Admit to hospital
Continue supportive measures
Prescribe amoxicillin
Prescribe phenoxymethylpenicillin
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?
Continue star chart
Desmopressin
Enuresis alarm
Imipramine
Oxybutynin
Enuresis alarm
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?
Detain the patient under Section 5(2) of the Mental Health Act and provide emergency dialysis
Facilitate a Mental Health Act assessment
Facilitate an urgenT best interests assessment
Facilitate dialysis under common law, using sedation if required
Facilitate discharge and continue discussions with the patient in the community
Facilitate dialysis under common law, using sedation if required
A 50 year old man has been feeling low in mood and describes ‘not enjoying anything’ in recent weeks. He has difficulties concentrating at work, where his performance has been declining. He is unkempt and losing weight. He has seen his GP who initiated sertraline 100mg daily 1 month ago and referred him to the community mental health team. Which is the most appropriate next step in his management?
Add lithium
Add mirtazapine
Add olanzapine
Increase the dose of sertraline
Switch to dosulepin (a TCA)
Increase the dose of sertraline
A 25 year old woman is currently an informal inpatient on a mental health ward for management of a depressive episode. She has intent to end her life. She wants to leave the ward. She is deemed to have capacity to make a decision to leave hospital. Which is the next most appropriate step in management?
Allow her to self discharge
Detain her under the Deprivation of Liberty Safeguards
Detain her under the Mental Capacity Act
Detain her under the Section 2 of the Mental Health Act
Detain her under the Section 5(2) of the Mental Health Act
Detain her under the Section 5(2) of the Mental Health Act
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?
Acute stress reaction
Adjustment disorder
Depressive episode
Generalised anxiety disorder
Post-traumatic stress disorder
Acute stress reaction
- A 55 year old woman in General Practice has a history of recurrent depression. She has previously had cognitive behavioural therapy and antidepressant medication. She is currently well but her work has been stressful and she is worried her depression may recur. Which is the most appropriate next management option?
Group based CBT
Mindfulness-based cognitive therapy
Prescribe prophylactic SSRI
Prescribe zopiclone
Regular follow up with GP and screening for depression
Mindfulness-based cognitive therapy
A 24 year old woman in her first pregnancy, is in spontaneous labour on the labour ward. She is using Entonox for analgesia and has now been in the second stage for 3 hours. She has been in good descent from pushing for 2 hours. The baby is in the cephalic presentation in an occipito-anterior position, vertex below the ischial spines. The foetal heart rate has been suspicious for 30 minutes. Which is the most appropriate management in this scenario?
Caesarean section
Epidural analgesia
Episiotomy
Forceps delivery
Ventouse delivery
Forceps delivery
A 27 year old woman is seen in the antenatal clinic for a routine appointment. She has a black eye which has been covered with makeup. When asked, she does not provide a clear cause for her injury. Which is the most appropriate initial course of action.
Refer to safeguarding midwife
Refer to the Caldicott guardian
Refer to the Emergency Department
Refer to the police
Refer to women’s aid
Refer to safeguarding midwife
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?
Amniocentesis
Chorionic villous sampling
Non-invasive pre-natal testing (cell free DNA)
Nuchal translucency
Quadruple test
Non-invasive pre-natal testing (cell free DNA)
A 27 year old woman in the early pregnancy unit has light vaginal bleeding, 6 weeks after her last menstrual period. Transvaginal ultrasound scan (USS) shows an intrauterine gestation sac. There was no visible yolk sac or foetal pole. Which is the recommended management?
Arrange a repeat USS in 10-14 days
Arrange a repeat USS in 48 hours
Offer management for miscarriage
Reassure and discharge
Take beta-HCG and repeat in 48 hours
take beta-HCG and repeat in 48 hours
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?
Back to routine smear recall
Colposcopy in 6 months
No follow up required
Vault smear in 6 months
Vault smear in 12 months
No follow up required
A 22 year old woman with cystic fibrosis attends the obstetric medicine clinic for preconception counselling. Development of which obstetric complication is she at greatest risk, given her pre-existing disease?
Foetal congenital malformation
Gestational diabetes
Obstetric cholestasis
Pregnancy induced hypertension
Spontaneous miscarriage
Pregnancy induced hypertension
A 40 year old woman with uterine fibroids require the active management of the third stage of labour. At which point in labour should IM syntocinon (oxytocin) be administered?
When the anterior shoulder has been delivered
When the head has been delivered
When the neonate has been delivered
When the trunk has been delivered
When the vertex is crowning
When the anterior shoulder has been delivered
A 55 year old woman in gynaecology outpatients has a BMI of 23.5 kg/m2 and a history of stress incontinence. Pelvic floor exercises have not improved her symptoms. Which is the most appropriate next step in management?
Hysterectomy
Intra urethral bulking
Ring pessary
Surgical repair
Weight loss
Intra urethral bulking
A 19 year old woman presents with an acutely painful large swelling near the opening of the vagina. She is unable to sit and passing urine is uncomfortable. Her last menstrual period started 2 days ago. Which is the most likely diagnosis?
Bartholin’s abscess
Bartholin’s cyst
Congenital urethral cyst
Urinary tract infection
Vaginal endometriosis
Bartholin’s abscess
A 34 year old woman attends her GP for her 32 week antenatal appointment. She feels well in herself and has regular foetal movements. She has had normal scans to date and an uncomplicated pregnancy. Her temperature is 36.8C, pulse 93 bpm, blood pressure 113/72 mmHg, and oxygen saturation 98% breathing air. Her booking blood pressure was 110/68 mmHg.
Urinalysis - negative
Ketones - negative
Blood - negative
Protein - 2+
Nitrites - negative
Leukocytes - negative
Which is the most appropriate next step in management?
Ask midwife to review in 2 weeks
Reassure and review at 36 week antenatal appointment
Refer for antenatal same day assessment
Send a mid-stream urine for microscopy, culture and sensitivity
Send a protein creatinine ratio
Refer for antenatal same day assessment
A 30 year old woman presents to General Practice 2 weeks after delivery of her first baby. She has low mood, exhaustion, difficulty sleeping, and is very tearful for the last week. She felt well during her pregnancy. She is bonding well with her baby and has good support at home. She has a history of depression but has been stable for the last 2 years. She has no thoughts of self-harm or suicide. Which is the most likely diagnosis?
Adjustment disorder
Baby blues
Dysthymia
Postnatal depression
Recurrent depression
Postnatal depression
A 35 year old woman in General Practice has epilepsy and is currently taking sodium valproate and desogestrel. She has not had a seizure for 13 months. She and her boyfriend would like to conceive a child. Which is the most appropriate management option?
Perform blood tests to check sodium valproate levels
Reduce sodium valproate dose
Refer to epilepsy clinic, continue current medication in the meantime
Refer to epilepsy clinic, meanwhile switch to a different anti-epileptic
Stop all medication now and refer to epilepsy clinic
Refer to epilepsy clinic, continue current medication in the meantime
A widespread rash is found on a 2 day old baby at his newborn check (see image). He is feeding well, is active and has no fever. What is the most appropriate management?
Nothing
A 6 year old girl with known sickle cell disease is in the Emergency Department with lethargy and shortness of breath. This is in the context of a recent febrile illness with a rash that has now resolved. Her blood results show: Hb 45 g/L (115 - 140), WBC 2.8 x 10^9/L (3.8 - 10), platelets 55 x 10^9/L (150 - 400). What pathogen is likely to have caused this presentation?
Parvovirus B19
The mother of a 3 year old boy in General Practice has noticed that her son’s foreskin is ballooning on urination. The foreskin is non-retractile. There is no redness or discomfort. What is the most likely diagnosis?
Phimosis
A 5 month old girl in General Practice has a worsening nappy rash for the last 2 weeks despite regular nappy changes, barrier cream and nappy-free time. She is feeding normally and otherwise well. Her temperature is 36.8C, and pulse rate 128 bpm. The rash is depicted in the image provided. What is the most appropriate management option in this scenario?
Keep clean and dry + barrier cream with castor oil and zinc
A 30 year old man with a brain injury following a road traffic accident reports experiencing an odd smell of burnt plastic. He is surprised that this is not bothering his flatmates. He recently reported seeing an image of Jesus on the walls of his bedroom reciting the ten commandments. What is the most likely diagnosis?
Post traumatic delirium
A 75 year old man with recurrent depressive disorder stopped taking his medication 1 month ago. He now has significant low mood and suicidal thoughts. He is admitted informally following an apparent attempt to hang himself. His wife died of cancer 2 years ago and he has no children. What level of observation should be provided by the ward nursing staff in this scenario?
1:1
A 61 year old man with alcohol dependence is brought to the Emergency Department by ambulance following concerns by neighbours. He presents with confusion and disorientation. He is irritable, tremulous and sweating. He appears to be responding to external visual stimuli. His temperature is 37.9C, pulse rate 125 bpm, BP 140/95 mmHg, respiratory rate 20 breaths per minute and oxygen saturation 95% breathing air. His breathalyser reading is 80 microgram alcohol / 100 mL of breath (legal limit for drivers <35). What is the most likely diagnosis?
Delirium tremens
A 13 year old boy attends the child psychiatry clinic with his parents, who describe a 7 month history of overeating. He frequently rummages through the cupboards at odd times of the day. He has said at times that he feels fat. His BMI is 18.5 kg/m2 (just under the 50th centile for his age). He has calluses on his knuckles. He performs well academically. What is the most likely diagnosis?
Bulimia nervosa
A 20 year old woman in the outpatient clinic has sudden episodes of palpitations, shortness of breath, sweating, chest pain and dry mouth. These episodes started 6 months ago, occur randomly and last for about 15 minutes. Education and lifestyle modification advice have not been helpful. What is the most appropriate next step in regards to her management?
CBT
An 18 year old girl in General Practice has had no periods for the previous 4 months. She had the contraceptive implant inserted 2 years ago. She reports missing meals as she has been stressed for her university exams. She admits to making herself vomit occasionally when she is stressed. Her temperature is 36.8C, pulse rate 65 bpm, BP 109/70 mmHg, BMI 17.5 kg/m2. A pregnancy test is negative. What is the most likely diagnosis? =
Anorexia nervosa
A 36 year old woman presents with spontaneous rupture of membranes at 33 weeks’ gestation. She has no abdominal pain. Speculum examination confirms a <1cm dilated cervix. She has no allergies. Her temperature is 36.6C, pulse 88 bpm, BP 110/55 mmHg, respiratory rate 16 breaths per minute, oxygen saturation 99% breathing air. What antibiotic should be prescribed in this scenario?
IV Benzylpenicillin
An active 50 year old who has no medical problems has a total abdominal hysterectomy for large multiple fibroids. She loses 300mls of blood. The procedure is uncomplicated. For how long should she be advised to take bed rest following discharge home?
6 weeks
A woman is due to have an elective caesarean section for breech presentation at 39 weeks’ gestation. For how many hours should she be fasted for solids prior to the operation?
6 hours
A 19 year old woman complains of irritability, aggression and low mood every month. She has no other medical conditions, takes no regular medication and is sexually active. The symptom diary shows that her work and social life are being affected in a cyclical way. What, specifically, is the aim of the hormonal management in this scenario?
Reduce premenstraul syndrome symptoms
A 27 year old woman has a complete molar pregnancy and only receives surgical management. She subsequently has regular serum beta-HCG monitoring. For how long should she be told to avoid pregnancy after the beta-HCG has returned to normal? (Your answer should be expressed numerically in the form: X months) =
12 months
A 24 year old woman with a BMI of 22 kg/m2, has an elective, uncomplicated laparoscopic procedure for removal of a 6 cm simple ovarian cyst. Assuming good postoperative recovery, after how long would she be appropriate to be discharged? (Your answer should be expressed numerically in the form: X hours)
24 hours
A 30 year old woman in the third trimester of her first pregnancy develops an itchy, bumpy rash on her abdomen, with sparing of the periumbilical area. She is usually fit and well and has had an uneventful pregnancy so far. What is the most likely diagnosis?
pruritic urticarial papules and plaques of pregnancy (PUPPP)
A 36 year old woman presents with a 4 day history of lower abdominal pain, dyspareunia and offensive vaginal discharge. She denies any bowel or urinary symptoms. She takes the combined oral contraceptive pill only and denies any missed pills. Her temperature is 38.2C. Her lower abdomen is mildly tender on palpation. Vaginal and speculum examinations are normal and pelvic swabs are taken. Her urine dipstick is normal. What is the most likely diagnosis?
Pelvic inflammatory disease
Woman with a little bit of pink post-coital bleeding on wiping. Smear is fine, ultrasound is clear. What is the next investigation?
TRIPLE SWAB
Total abdo Hysterectomy yesterday. Woman goes upstairs and faints. Normal BP. DX.
Vasovagal syncope/ortho hypotension
Gravidity and Parity - currently pregnant woman with hx of 1 x 37 week stillbirth, 1 x current 7 week pregnancy, 1 x premature baby, 1 x miscarriage
G5P2
Girl with dyskaryosis has colposcopy and biopsy showing CIN1. When should next colposcopy be?
1 year
- 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
anti-ttg? or no Ix
- 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
SCID
- 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
Nebulised adrenaline
- 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
Turner’s syndrome
- 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
Offer simple analgesia and reassurance
- 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
go to A+E
- 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
Immediately discuss with on call paediatrician
- 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
Opiate withdrawal syndrome
- 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
CBT
- 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
Change to an antidepressant of another class
- 18 y/o man admitted under MHA to inpatient mental health unit for anorexia nervosa. He is commenced on nasogastric feeds and begins to show signs of confusion, weakness, and dyspnoea. Which electrolyte abnormality is most likely to be seen?
a. Hypercalcaemia
b. Hyperkalaemia
c. Hypomagnesaemia
d. Hyponatraemia
e. Hypophosphataemia
Hypophosphataemia
- 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
Cocaine intoxication
- 58 y/o man attends addiction services for initial alcohol dependence assessment. He regularly attends A&E following overdose attempts. He requests detoxification. He lives alone with few social contacts and has poorly controlled asthma. What is the most appropriate next step in management?
a. CBT
b. Community detoxification
c. Disulfiram
d. Inpatient detoxification
e. Motivational interviewing
SURELY inpatient
- 28 y/o woman with history of depressive disorder is referred to community mental health team with a 3 day history of increased energy and restlessness; she has been working till 02:00 and writing new articles (she is the creative director of a magazine). She recognises that this is unusual for her, describes her mood as 10/10, and says she feels creative and full of ideas. What is the most likely diagnosis?
a. Agitated depression
b. Hypomania
c. Manic episode
d. Schizoaffective disorder
e. Schizophrenia
Hypomania
- 24 y/o seen in GP for 6 months of low mood, poor concentration, and trouble sleeping. He denies suicidal ideation or self-harm. He denies drinking excessively, smoking at all, and using recreational drugs. He is a waiter and is struggling at work and has a PHQ-9 of 6 (mild severity). What is the most appropriate course of action?
a. Advise mindfulness classes
b. Refer for CBT
c. Start Citalopram
d. Start Fluoxetine
e. Write a fit note (medical certificate) for 4 weeks
Refer for CBT
- 42 y/o woman is 34 weeks pregnant and has had repeat admissions for severe abdominal pain. She currently needs opiate analgesia but is still struggling with the pain. USS shows a sub-serosal fibroid measuring 7cm x 9cm. What is the best management option for her pain?
a. Continuous regular opiates
b. Epidural anaesthesia
c. NSAIDs
d. Remifentanyl patient-controlled analgesia
e. Uterine artery embolisation
Continuous regular opiates
- 40 y/o woman is successfully treated for ectopic pregnancy with methotrexate. After what interval may she safely conceive again?
a. 1 year
b. 3 months
c. 6 months
d. Her next menses
e. Immediately
3 months
- A woman is having a repeat USS at 32 weeks gestation for a previously low-lying placenta. The USS shows the placenta is clear of the cervical os and an additional succenturiate lobe is seen. Which condition needs to be excluded in the USS?
a. Cervical shortening
b. Fetal growth restriction
c. Placenta praevia
d. Vasa praevia
e. Velamentous cord insertion
Vasa praevia
- 63 y/o woman presents with a 2 week history of post-menopausal vaginal bleeding. BMI is 39.2. Pelvic USS shows irregular endometrial thickening (14mm). Outpatient endometrial sampling fails because of cervical stenosis. What is the most appropriate management?
a. CT abdomen and pelvis
b. Hysteroscopy with dilatation and curettage
c. Repeat USS in 2 weeks
d. Total abdominal hysterectomy + bilateral salpingo-oopherectomy
e. Total laparoscopic hysterectomy + bilateral salpingo-oopherectomy
Hysteroscopy with dilatation and curettage
- 29 y/o woman with past history of cocaine and cannabis use denies using for the past 3 years. Which additional test should be done for this patient at booking?
a. Hair toxicology screen
b. Hepatitis C
c. Hepatitis E
d. Serum toxicology screen
e. Urine toxicology screen
Hep C
- 33 y/o woman has Ventouse delivery at 39 weeks gestation and requires manual removal of placenta. The removal is uncomplicated with an EBL of 600ml. She plans to mix feed her baby for the first 6 months. When can she expect her menstrual cycle to return?
a. Cannot be predicted
b. When she is more than 50% bottle feeding
c. When she stops breastfeeding
d. Within 6 months
e. Within 6 weeks
CANNOT predict
- 29 y/o attends A&E with SOB, abdo pain, nausea, bloating, and feeling faint. She is having her first cycle of IVF and had her embryo transfer 3 days ago. What is the most likely diagnosis?
a. Ectopic pregnancy
b. Miscarriage
c. Ovarian hyperstimulation syndrome
d. Pulmonary embolism
e. Ruptured ovarian cyst
Ovarian hyperstimulation syndrome
- 60 y/o woman presents with discomfort during sex and vaginal dryness. What is the best management option?
a. Commence oral HRT
b. Commence SSRI
c. Commence topical vaginal oestrogen
d. Commence transdermal HRT
e. Commence vaginal lubricants
Commence topical vaginal oestrogen
- 32 y/o woman has diagnostic laparoscopy to investigate pelvic pain, and has a catheter inserted in recovery for urinary retention. The catheter is removed the next morning. When can she be safely discharged home?
a. When she has voided more than 200ml
b. Straight away with advice to return if she has problems voiding
c. When her post-void residual volume is 0ml
d. When her post-void residual volume is 100ml
e. When her post-void residual volume is 300ml
When her post-void residual volume is 100ml
- 25 y/o woman who is 38 weeks pregnant is seen in triage for irregular painful contractions lasting 6 hours. She took paracetamol 6 hours ago. She is examined and found to be 2cm dilated. Which analgesia is most appropriate?
a. Co-dydramol
b. Epidural analgesia
c. Nitrous oxide
d. NSAID
e. Warm bath
co-drydamol
- 41 y/o women attends her dating scan. LMP dates make her 12 weeks pregnant. An intrauterine pregnancy is seen with no fetal heartbeat. CRL is equivalent to a fetus of 9 weeks gestation. What is the best next step?
a. Admit her for laparoscopy
b. Counsel her on management options for miscarriage
c. Offer her a repeat USS in 1 week
d. Offer treatment with methotrexate
e. Serum beta-hCG now and repeat in 48 hours
Counsel her on management options for miscarriage
- 37 y/o woman has her anomaly scan at 20+3 weeks of pregnancy, and it reveals echogenic bowel. What is the most likely cause?
a. Duodenal atresia
b. Incidental finding
c. Male gender
d. Trisomy 18
e. Trisomy 21
trisomy 21
- A Rh negative woman has light vaginal bleeding and pain at 9 weeks gestation. USS shows a viable 9 week intrauterine pregnancy. The bleeding resolves 48 hours later. What further treatment does she require?
a. 250IU Anti-D prophylaxis immediately
b. Kleihauer test
c. No further action
d. Progesterone pessaries
e. Repeat scan in 2 weeks
no further action
- 42 y/o Afro-Caribbean woman presents with ongoing menorrhagia. A uterine fibroid is identified on TVUSS, and a trial of tranexamic acid has not helped. Which is the next most appropriate management step?
a. COCP
b. Intrauterine coil device
c. IUS
d. Mefenamic acid
e. Refer to gynaecology
IUS
- 36 y/o woman sees GP for routine appointment at 32 weeks pregnancy. This is her first pregnancy and has so far been uncomplicated. She has normal fetal movements and is generally well with temperature 36.3, HR 90, BP 128/82, RR 13, O2 sats 96% on room air. Fundal height is 32cm and fetal HR is normal. Urine dipstick shows ++ protein but no other abnormalities. What is the most appropriate management?
a. Immediate referral to obstetrics
b. Repeat urinanalysis in 1 day
c. Repeat urinanalysis in 1 week
d. Send urine for MC&S and start Nitrofurantoin
e. Send urine for MC&S and start Trimethoprim
Immediate referral
- 2 y/o girl has a fever of 39.7 and a painful, swollen right eye with preserved eye movements (see picture below). What is the most appropriate first-line treatment?
Oral co-amoxiclav
- 13 y/o girl seen in GP with fever, sore throat, and cervical lymphadenopathy. Her temperature is 37.9 and she has white exudates on enlarged tonsils. She is prescribed Amoxicillin 500mg TDS, then 7 days later re-presents with a widespread rash (see picture below). What is the most likely causative organism?
EBV
Baby born 1 day ago. what is this
erythema toxicum
Pregnant lady with bullous rash on R forearm, started at umbilicus and spread from there.
pemphigus gestationis
