SPECIALTIES 2020 Flashcards
(167 cards)
1
Q
2 y/o girl with a 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
A
Nebulised adrenaline
2
Q
2y/o has episodes of falling to the ground whilst tightening and stiffening his hands, accompanied by screaming and sweating. During the episodes the child is inconsolable but between episodes the child is well with normal development. What is the most likely diagnosis?
Hyperactivity
Reflex anoxic seizure
Temper tantrum
Tonic-clonic seizure
Vasovagal syncope
A
Temper tantrum
3
Q
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?
Colonoscopy with biopsies
No investigations at this stage
Stool microscopy, culture, and sensitivity
Tissue transglutaminase antibody titres
Urgent abdominal x-ray
A
No investigations at this stage
4
Q
5 y/o presents with widespread non-blanching erythematous rash over her body, after 1 week of cough and coryzal symptoms. Teperature is 37.2, pulse 95bpm, BP 90/60, RR 22, and O2 sats are 98% on room air. Urinanalysis yields no abnormalities, but FBC shows elevated WCC and a platelet count of 7 x 10^9. What is the most likely diagnosis?
Acute lymphoblastic leukaemia
Henoch-Schonlein purpura
Haemophilia
Von Willebrand disease
Immune thrombocytopenic purpura
A
ITP
5
Q
9 m/o boy is brought to A&E with vomiting and lethargy. He has a purpuric rash and bulging anterior fontanelle. His temperature is 40, HR 160, RR 55, capillary refill is 3 seconds and O2 sats are 100% on supplemental oxygen. He has no neck stiffness and Kernig’s sign is negative. What is the most likely cause?
Group B Streptococcal disease
Henoch-Schonlein purpura
Measles
Meningiococcal disease
Viral meningitis
A
Meningiococcal disease
6
Q
7 y/o girl in GP practice with a 6 month history of central abdominal pain. Height and weight is growing steadily along the 50th centile. She has no other symptoms but recently has been reluctant to attend school. Abdomen SNT, temperature 36.9, HR 91, BP 98/60, RR 20, and O2 sats are 98% on room air. What is the most likely diagnosis?
Coeliac disease
Functional abdominal pain
Inflammatory bowel disease
Irritable bowel syndrome
Mesenteric adenitis
A
Functional abdominal pain
7
Q
6 m/o seen in A&E is distressed and blue around the mouth. Temperature 36.5, HR 170, RR 35, O2 sats 83% on room air. He has a loud ejection systolic murmur at the upper left sternal edge. He has dropped from the 50th to the 3rd centile for weight. What is the most likely cause of the murmur?
Atrial septal defect - acyanotic soft, mid-systolic murmur
Innocent murmur
Tetralogy of Fallot
Transposition of the Great Vessels - cyanotic congenital heart defect, it usually presents with severe cyanosis shortly after birth.
Ventricular septal defect - pansystolic murmur and is an acyanotic defect
A
Tetralogy of Fallot
8
Q
22 m/o child had cough and coryza for 2 days, and is now struggling with breathing. She has subcostal and intercostal recessions and widespread wheeze. Her temperature is 37.3, HR 125, RR 45, O2 sats 98% on room air. What is the most appropriate next step in her management?
0.5L/min supplemental oxygen
2 puffs beclomethasone inhaler
10 puffs salbutamol inhaler
Intravenous aminophylline
Oral prednisolone
A
10 puffs salbutamol inhaler
8
Q
3 month old boy has 2 days of fever and crying accompanied by reduced feeding and fewer wet nappies. Temperature 38.0, HR 170, RR 38, O2 sats 97% on room air. He has reduced movement in his right leg, chest is clear, urinanalysis is normal and anterior fontanelle is slightly sunken. What is the most likely diagnosis?
a. Developmental dysplasia of the hip
b. Non-accidental injury
c. Osteomyelitis
d. Reactive arthritis
e. Sickle cell crisis
A
Osteomyelitis
9
Q
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
A
Severe combined immunodeficiency
10
Q
A 19 month old girl has been able to sit unsupported for 1 month. She can speak 11 words and feed herself. She was born at 30 weeks. Which is the best description of her current development?
Fine motor delay
Gross developmental delay
Gross motor delay
Mild developmental delay
Normal development
A
Gross motor delay
11
Q
A 3 y/o boy has pruritis ani which is worse at night. He has no abdominal pain and bowel movements are normal. He is growing well and his development is normal. What si the most appropriate course of action?
Chlorpheniramine solution
Hydrocortisone
Macrogol sachet
Mebendazole solution
Miconazole cream
A
Mebendazole solution
12
Q
6 y/o boy’s parents have noticed long-standing hearing difficulties and take him to GP. Teachers have commented on poor school performance and behaviour. Speech is normal and there is no otalgia. The ear canals are narrow with non-occluding wax. Which is the most appropriate next step in his management?
Aural olive oil drops
Grommet insertion
Pure tone audiometry
Referral for hearing aids
Review in 3 months
A
Pure tone audiometry
13
Q
3 y/o boy with an URTI has temperature of 38.5, HR 125, BP 95/60, RR 18, O2 sats 92%. Oxygen is given, then while being examined the boy develops jerky motions of his limbs which have now lasted 5 minutes continuously and he is not responding to his mother’s voice. His lips are cyanosed and he has irregular gasping respirations. There is no skin rash and his capillary blood glucose is normal at 4.5. What is the most appropriate immediate management option?
Buccal midazolam
Intramuscular benzylpenicillin
Intravenous glucose
Oral paracetamol
Subcutaneous adrenaline
A
Buccal midazolam
14
Q
Boy born at 40 weeks with male phenotype, but neither testicle can be palpated on examination. What is the most likely diagnosis?
Androgen insensitivity syndrome
Excess in utero oestrogen exposure
Klinefelter’s syndrome
Physiological delay in descent
Retractile testes
A
physiological delay
15
Q
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
A
. Turner’s
16
Q
3 week old baby referred for prolonged jaundice, dark wet nappies, and pale stools. There are no developmental concerns and he is currently breastfed. Birth weight was 3.45kg and he currently weighs 3.2kg, Temperature is 37.1, HR 140, RR 45, O2 sats 98% on room air.
Investigations:
Hb 110 (normal)
WCC 6 (normal)
Platelets 430 (slightly high)
Bilirubin 175 (high)
Conjugated bilirubin 100 (high)
ALP 160 (normal)
ALT 35 (normal)
Albumin 25 (lower end of normal)
Sodium 137 (normal
Potassium 4 (normal)
What is the most appropriate next step in management?
Feeding advice
Inpatient ultrasound
I.V. antibiotics
Outpatient ultrasound
Phototherapy
A
inpatient uss
17
Q
5 y/o boy with 2 days of fever, runny nose, cough, and sore throat. He developed a rash over the past 24 hours, temperature 39.2, HR 105, RR 30, capillary refill <2 seconds and O2 sats are 98% on room air. There is cervical lymphadenopathy, a red tongue, cracked lips, and a fine erythematous macular rash all over his body. Which is the most effective treatment?
Aciclovir
Aspirin
Co-amoxiclav
Paracetamol
Phenoxymethylpenicillin
A
Phenoxymethylpenicillin
18
Q
18 m/o presents to GP with 1 day history of left ear pain. There is no discharge and mum reports a 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?
Offer simple analgesia and an immediate prescription of amoxicillin
Offer simple analgesia and ciprofloxacin ear drops
Offer simple analgesia and delayed prescription of amoxicillin
Offer simple analgesia and gentamicin ear drops
Offer simple analgesia and reassurance
A
Offer simple analgesia and delayed prescription of amoxicillin
19
Q
A 5 year old boy seen in GP with a rash across buttocks (see below) on a background of 4 days of cough, coryza, and mild fever, but he is otherwise generally well. Temperature 37.4, HR 105, capillary refill <1s, RR 25, O2 sats 99% on room air. What is the most likely diagnosis?
Discoid eczema
Henoch-Schonlein purpura
Idiopathic thrombocytopenic purpura
Menigiococcal septicaemia
Viral exanthem
A
Henoch-Schonlein purpura
20
Q
A 2 y/o in GP has a 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?
Immediate referral to Paediatric A&E
Give oral Aciclovir for 1 week
Give oral Flucloxacillin for 1 week
Give topical dermovate
Give topical fusidic acid
A
Immediate referral to Paediatric A&E
21
Q
A 3 y/o boy in GP has left-sided neck lump on a background of 6 days of coryza, cough, and mild fever, but no systemic symptoms. Temperature 37.0, HR 105, capillary refill <1s, RR 26, O2 sats 99% on room air. ENT exam is normal and chest is clear. He has a single enlarged lymph node in the left posterior chain. What is the most appropriate next step in management?
Arrange urgent ENT referral
Arrange USS
Arrange urgent FBC
Prescribe Amoxicillin 250mg TDS for 7 days
Reassurance and watchful waiting
A
Reassurance and watchful waiting
22
Q
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?
Immediately discuss with on call paediatrician
Reassure and review in 4 weeks
Refer for a non-urgent MRI brain scan
Refer to neurologist under 2 week wait
Routine bloods
A
Immediately discuss with on call paediatrician
23
Q
AN 8 y/o boy is forgetful and fidgety, and teachers report he has always been disruptive in class, has had difficulty concentrating, and finds it hard to make friends. His symptoms occur every day of the week. Which is the most likely diagnosis?
ADHD
Anxiety
Autistic spectrum disorder
Bullying
Oppositional defiant disorder
A
ADHD
24
6 y/o boy in GP with 3 week history of intermittent limp and occasional complaints of pain in left hip. Mother reports no trauma or other symptoms. What is the most likely diagnosis?
a. Osteomyelitis
b. Perthes disease
c. Rickets
d. Septic arthritis
e. Soft tissue injury
Perthes disease
25
9 m/o boy with fever of 38.5 brought to GP by mother but sent away with paracetamol. Re presents 4 days later when child develops facial rash (red cheeks) but is otherwise well. What is the most likely diagnosis?
a. Eczema herpeticum
b. Erysipelas
c. Impetigo
d. Non-accidental injury
e. Parvovirus B19
B19
26
2 y/o boy in GP with 3 days of fever, coryza, poor appetite and a 24 hour history of rash (see below). Temperature 38.5, HR 110, capillary refill <2s, and O2 sats 99% on room air. What is the most likely diagnosis?
Chickenpox
Hand foot and mouth disease
Herpes simplex
Impetigo
Molluscum contagiosum
hand foot and mouth
27
A 7 y/o boy in GP with bedwetting for 2 months having previously been dry at night since age 4. Abdo exam is normal. What is the most appropriate initial investigation?
Abdominal USS
Abdominal x-ray
Finger prick glucose test
Renal function
Urine dipstick
Urine dipstick
28
16-hour old baby is jaundiced, has yellow stools, is sleepy, and is not feeding. The mother was positive for Group B Streptococcus in her previous pregnancy. What is the most likely diagnosis?
Group B Streptococcus Sepsis
29
A baby is born with 45XO karyotype. What is the most likely cardiac abnormality associated with this syndrome?
Bicuspid aortic valve
30
Child has difficulty breathing, lip swelling, a rash, and wheeze. What is the definitive first-line treatment in this scenario (give drug and route of administration)?
Intramuscular adrenaline
31
15 y/o boy has worsening severe headaches for 1 month and has been vomiting in the morning. There is no history of trauma and he is afebrile. What definitive investigation should now be requested?
MRI brain
32
5 y/o boy has a systolic murmur which is soft and audible at the left sternal edge. The boy is asymptomatic. What is the most likely diagnosis?
innocent murmur
33
Child has weight loss, diarrhoea, and positive Endomysial and tissue Transglutaminase antibody tests. What is the most likely diagnosis?
Coeliac disease
34
Child has symptoms of perennial rhinitis (blocked nose, nasal voice, running eyes). What is the most likely causative allergen in this scenario?
house dust mite
35
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?
IV cefotaxime
(oral co-amov for less severe/no fever)
36
A 6 y/o girl has cloudy urine but no dysuria or frequency. Her parents say her urine looks like beer. She has had a recent upper respiratory tract infection. What is the most likely diagnosis?
post strep glomerulonephritis
37
A 7 year old boy with juvenile idiopathic arthritis has been on treatment for 1 year. He has experienced weight gain, dark striae on his abdomen and thighs, and a round plethoric face. Which medication is likely to be responsible?
prednisolone
38
A ‘clunk’ is felt when examining the hips of a 48 hour old baby at the routine check. Which investigation should now be requested?
USS hip
39
A child who was late to start walking, but who had otherwise normal development, has bowed legs. What is the most likely cause?
rickets vitamin D deficiency
40
15 y/o girl weighs 100kg. She has striae and darker skin in her armpits and neck. She has been feeling tired and has had episodes of vulval thrush, but is otherwise well. A blood test shows a fasting blood glucose of 7.6mmol/L (3-6 normal range). What pharmacological treatment should be considered?
metformin
insulin
41
Mother with SLE has a baby who is born with a slow heartbeat. What is the most likely diagnosis?
SLE
42
2 y/o boy has suddenly started crying and intermittently pulling his legs up. He has vomited several times, and the last vomitus was green. He has not opened his bowels for several hours. He is resuscitated appropriately. What is the definitive management for this condition?
intuss -> rectal air insufflation
43
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
44
4 month old in GP has non-bilious vomiting after feeds and persistent crying, but a normal amount of wet and soiled nappies. She is meeting her developmental milestones and growing well along the 25th centile. What is the most likely diagnosis?
gastro-oesophageal reflux
45
2 month old boy attends GP with fever, rash, and coryza. He is taking 70% of his normal feeds and is producing a normal number of wet nappies. There is a non-blanching petechial rash on his left arm. Temperature 38.9, HR 148, RR 43, and O2 sats 98% on room air. What is the most appropriate pharmacological management to give in the GP surgery?
IM benpen
46
2 week old boy in GP has bilateral red eyes with purulent discharge since birth. What is the most likely causative organism?
chlamydia trachomatis
47
15 y/o has non-productive cough and wheeze for 2 months that is worst at night. Two courses of antibiotics have not helped it. Temperature 37.0, HR 80, BP 105/70, RR 20, O2 sats 99% on room air. What is the most appropriate first-line management?
salbutamol
48
8 y/o boy struggles to follow instructions for school work and can’t organise his time effectively to complete assigned tasks. He is fidgety and disrupts others in the class by interrupting of by being ‘on the go’ when expected to sit still. What would be the most appropriate medication?
methylphenidate
49
29 y/o woman visits GP with heavy sensation in her vagina when exercising. She is aware of a bulge in her vagina, sometimes associated with a desire to urinate. She had a vaginal delivery 2 years ago. O/E there is some laxity of the anterior vaginal wall but this does not descend to the introitus on straining. Urine culture is negative. What is the most appropriate management plan?
a. Oxybutynin hydrochloride
b. Pelvic floor exercises
c. Refer for urodynamic testing
d. Refer to urogynaecology clinic
e. USS of pelvis
pelvic floor
50
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
Remifentanyl patient-controlled analgesia
51
60 y/o woman has hysteroscopy for post-menopausal bleeding. Biopsy shows suspicious endometrial lesion. What is the most appropriate management plan?
a. Admit to gynaecology ward
b. Follow up with GP
c. Gynaecology appointment within 6 weeks
d. Gynaecology telephone clinic appointment in 1 week
e. See in gynaecology clinic within 2 weeks
See in gynaecology clinic within 2 weeks
52
33 y/o woman 32 weeks pregnant has glycosuria for the second time. Fundal height is 36cm and the fetal parts are difficult to palpate. Her routine glucose testing at 27 weeks was normal. What is the most appropriate next step in her management?
a. Advise low glycaemic index diet
b. Perform 75g glucose tolerance test
c. Send HbA1c
d. Start Insulin
e. Start Metformin
Perform 75g glucose tolerance test
53
37 y/o woman is 16 weeks pregnant and had close contact with neighbour 4 days ago who now has chicken pox. She doesn’t think she’s had it before. What is the best course of action?
a. Ask her to attend antenatal clinic for urgent assessment
b. Check booking bloods for presence of VZV IgG
c. Fetal USS in 2 weeks
d. Give IVIg Infusion
e. Give VZV vaccine
Check booking bloods for presence of VZV IgG
54
34 y/o nulliparous woman presents with chronic pelvic pain. Bimanual exam reveals a fixed retroverted uterus with tender nodules on the utero-sacral ligaments. What is the most likely diagnosis?
a. Adenomyosis
b. Endometriosis
c. Inflammatory bowel disease
d. Ovarian carcinoma
e. Pelvic inflammatory disease
endometriosis
55
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
56
26 y/o woman has oophorectomy for a 20cm ovarian cyst which was found on USS and described as “complex with solid areas”. Serum Ca125 was normal and on pathological examination the cyst contained dirty fluid, fat, hair shafts, and greasy material. What is the most likely diagnosis?
a. Mature cystic teratoma
b. Mucinous cystadenocarcinoma
c. Mucinous cystadenoma
d. Serous cystadenocarcinoma
e. Serous cystadenoma
Mature cystic teratoma
57
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
58
Which of the following is a complication of 3rd trimester Ibuprofen use?
a. Acute kidney injury
b. Closure of ductus arteriosus
c. Liver failure
d. Preterm labour
e. Reye’s syndrome
closure of ductus
59
A 32 y/o woman who is 30 weeks pregnant presents to A&E with abdo pain and small amount of vaginal bleeding. Temperature 37.2, HR 108, BP 90/62. Fetal heart rate is 220, and the uterus is tender and feels hard on palpation. What is the most likely diagnosis? a. Acute appendicitis
b. Chorioamnionitis
c. Placenta praevia
d. Placental abruption
e. Pyelonephritis
Placental abruption
60
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
61
A 32 y/o nulliparous woman is 8 weeks pregnant and experiencing severe nausea and vomiting that makes it impossible for her to work. She is taking 50mg cyclizine OD (once daily) with no effect. What is the best next management option?
a. Admit for I.V. fluids
b. Change to prochlorperazine
c. Increase frequency of cyclizine to TDS (three times daily)
d. Add a PPI
e. Add Prochlorperazine
Admit for I.V. fluids
62
A 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
Hepatitis C
63
A 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
a. Cannot be predicted
64
A 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
OHSS
65
A 20 y/o woman attends A&E. She realised 4 days after her menses finished that she had forgotten to remove her tampon. She has now removed it and is asymptomatic but concerned about the possible consequences. What is the most appropriate management? a. Advise vaginal douching
b. Arrange USS pelvis
c. Perform high vaginal swabs
d. Prescribe prophylactic antibiotics
e. Reassure and discharge
Reassure and discharge
66
A 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
67
A 61 y/o sexually active woman smoker referred to gynaecology clinic with 6 month history of vulval itch. There is an 8mm raised and tender lesion on the right labium majorum. What is the most appropriate next step?
a. Perform a cervical smear
b. Perform a high vaginal swab
c. Perform a VDRL test
d. Perform a vulval biopsy
e. Perform viral swabs
Perform a vulval biopsy
68
A 17 y/o girl has delayed menarche and short stature. Investigations:
FSH 70 (very high)
LH 40 (very high)
Which investigation is likely to produce a definitive diagnosis?
a. Karyotyping
b. MRI scan of pituitary fossa
c. Serum oestradiol
d. Thyroid function tests
e. Pelvic USS
karyotyping
69
40 y/o woman is having a normal vaginal delivery with planned active management of third stage. She has a history of essential hypertension. Which is the most appropriate drug to reduce risk of post-partum haemorrhage?
Dinoprostone (prostaglandin E2)
Ergometrine maleate
Labetalol hydrochloride
Magnesium sulphate
Oxytocin (Syntocinon)
Oxytocin (Syntocinon)
70
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?
When she has voided more than 200ml
Straight away with advice to return if she has problems voiding
When her post-void residual volume is 0ml
When her post-void residual volume is 100ml
When her post-void residual volume is 300ml
When her post-void residual volume is 100ml
71
A 36 y/o woman who is known to have a baby in breech position has ruptured her membranes on labour ward and is found to have cord prolapse. What is the definitive management of this scenario?
a. Category 1 C-section
b. Category 4 C-section
c. Fill bladder with 500mls normal saline
d. Knee-chest position
e. Replace cord in vagina and elevate presenting part
category 1 section
72
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-dydramol
73
A 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
74
A 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
duodenal atresia
75
A 29 y/o woman had had intermittent vaginal bleeding since insertion of the Mirena coil 6 weeks ago. What is the most appropriate investigation?
a. Cervical smear
b. Colposcopy
c. High vaginal swab
d. No investigation required
e. Transvaginal pelvic USS
no investigation needed
76
A woman with sickle cell trait is 8 weeks into an unplanned pregnancy. Which investigation should be offered first?
a. Chorionic villus sampling
b. Free fetal DNA testing
c. Partner FBC
d. Partner haemoglobin electrophoresis
e. Partner karyotyping
Partner haemoglobin electrophoresis
77
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
78
A 37 y/o woman who is 10 weeks pregnant presents with 1 week of excessive vomiting. The fundal height is consistent with a 16 week gestation pregnancy. Temperature 37.2, HR 100, BP 180/110. What is the primary pathology?
a. Gastroenteritis
b. Hyperemesis gravidarum
c. Molar pregnancy
d. Pre-eclampsia
e. Pregnancy-induced hypertension
molar
79
A 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
80
A 24 y/o woman has urge incontinence causing low mood. She previously had a clitoridectomy aged 7 years old in Somalia. She is nulliparous. She has two younger brothers. What is the most appropriate next step in her management?
a. Referral to FGM clinic
b. Referral to mental health team
c. Referral to police
d. Referral to social services
e. Referral to uro-gynaecology
Referral to FGM clinic
81
A 55 y/o woman in GP describes sudden need to urinate throughout the day with occasional leaks when she can’t make it to the bathroom in time. There is no dysuria and a urine dipstick is normal. What is the most appropriate management option?
a. Bladder training
b. Incontinence pads
c. Pelvic floor exercises
d. Tolterodine
e. Trimethoprim
Bladder training
82
A 36 y/o woman sees a GP for a 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 to obstetrics
83
A 19 y/o woman in GP has a 3 week history of post-coital vaginal bleeding. She had a Nexplanon (Progesterone-only subdermal implant) inserted 18 months ago and has been amenorrhoeic for the last 12 months. Vaginal and speculum exams are normal and urine pregnancy test is normal. What is the most appropriate next investigation? a. Blood test for clotting screen
b. Cervical cytology
c. Endocervical, chlamydial, and high vaginal swabs
d. Transvaginal USS
e. Urine for microscopy, culture, and sensitivities
endocervical, chlamydial, and high vaginal swabs
84
A 19 y/o woman attends GP for contraception review. She started Microgynon-30 14 months ago and reports a recent migraine without aura which lasted 2 days (which she has never experienced before). She is currently a smoker but has no other CVS disease or VTE risk factors. Her temperature is 36.5, HR 70, BP 115/63, RR 14, O2 sats 97% on room air, and her BMI is 21. What is the most appropriate next step in management?
a. Continue Microgynon-30 and offer smoking cessation
b. Continue Microgynon-30 and start Sumitriptan
c. Stop Microgynon-30 and offer Microgynon-20
d. Stop Microgynon-30 and offer progesterone-only contraception
e. Stop Microgynon-30 and start NuvaRing
Continue Microgynon-30 and offer smoking cessation
85
A 26 y/o woman has 24 hours of vulval rash and painful urination. What is the most appropriate treatment?
a. Oral aciclovir
b. Oral flucloxacillin
c. Topical aciclovir
d. Topical clotrimazole
e. Topical fusidic acid
oral aciclovir
86
A 29 y/o seen in GP wanting to conceive. She has epilepsy and her last seizure was 18 months ago. She currently has a copper IUD in situ and is taking sodium valproate 1000mg BD. What is the most appropriate management?
Leave IUD in situ, continue sodium valproate, and refer her for specialist advice
Remove IUD, continue sodium valproate 1000mg BD and start folic acid 5mg OD
Remove IUD, stop sodium valproate 1000mg and start carbamazepine 600mg BD and folic acid 5mg OD
Remove ID, stop sodium valproate, and start folic acid 400mcg OD
Leave IUD in situ, continue sodium valproate, and refer her for specialist advice
87
A 31 y/o woman in GP is 34 weeks pregnant and presents with dysuria, frequency, and urgency. Temperature 37.2, HR 80, BP 126/78, RR 18, O2 sats 99% on room air. She has mild suprapubic pain with no rebound or tenderness. What is the most appropriate initial management plan?
Arrange clinical review in 24 hours
No investigation required, treat empirically with antibiotics
Reassure, no treatment needed
Send urine for MC&S and treat empirically with antibiotics without waiting for results
Send urine for MC&S and treat with antibiotics based on the results
Send urine for MC&S and treat empirically with antibiotics without waiting for results
88
A 32 y/o woman presents to GP with dyspareunia, sweating, and low mood. She has not had a period in over a year, and has previously been treated with chemotherapy for breast cancer. What is the most appropriate investigation?
LH and FSH
Oestradiol level
Pelvic USS
Prolactin
Testosterone
LH and FSH
89
A 45 y/o woman who has had 2 vaginal deliveries undergoes urodynamic testing for urinary dysfunction. The report reveals unprovoked pressure peaks with urinary leakage. What is the most likely diagnosis?
urge incontinence
90
A 22 y/0 woman is planning a water birth. She is low risk with no medical problems. What complication of normal delivery is increased by a water birth?
umbilical cord snap/avulsion
neonatal infection
91
A woman visited by community midwife 8 days after a vaginal delivery. Her partner reports she seems confused and believes police want to take her baby away. What is the most likely diagnosis?
post partum psychosis
91
A 30 y/o woman is in labour at 37 weeks. She is 5cm dilated with intact membranes and is contracting at 4 in 10 minutes. She becomes agitated and starts behaving oddly. She complains of extreme SOB and suddenly collapses, then begins to bleed from her I.V. cannula site. Temperature 36.8, HR 108, BP 82/44, RR 22, O2 sats 78%. What is the most likely diagnosis?
amniotic fluid embolism
92
A 35 y/o woman has frothy and thin offensive yellow vaginal discharge. She is afebrile and last has sexual intercourse 3 weeks ago. She describes dysuria for the last few days and soreness and itchiness of her vulva. What is the most likely diagnosis?
trichomonas vaginalis
93
Which 4 strains of HPV are targeted by the current UK quadrivalent vaccination program?
6 11 16 18
94
An 80 y/o woman with a BMI of 25, COPD, and angina complains of back pain and a dragging sensation in her vagina. She has a uterine prolapse and a normal pelvic USS. What is the most appropriate treatment option?
ring pessary
95
An 8 y/o girl brought to gynaecology clinic with offensive vaginal discharge, but is otherwise well. What is the most likely cause?
vaginal foreign body
96
A 40 y/o woman has had miscarriages at 8 weeks, 11 weeks, and 22 weeks. She has also had one ectopic pregnancy for which she had a laparoscopic salpingectomy. Last year she has a stillbirth at 24 weeks gestation. She has one 4 year old daughter delivered at 39 weeks by C section, and is currently 6 weeks pregnant. What is her gravidity and parity (express as GxPx)?
G7P2 +4
97
A 28 y/o woman has a regular 35 day cycle. The first day of her LMP is 27/11/2019. What is her estimated delivery date?
10th september 2020
98
A 49 y/o woman has heavy, irregular menstrual bleeding. TVUSS shows a thickened endometrium with cystic spaces. What investigation would be diagnostic in this scenario?
endometrial biopsy
99
A 32 y/o with mild asthma has unexplained intra-uterine death at 37 weeks gestation. She is induced and has epidural analgesia and a spontaneous vaginal delivery. She is very distressed and would like to go home. What should be given to prevent her from expressing breast milk in this scenario?
cabergoline
100
A 21 y/o woman is 5 weeks pregnant with abdominal pain. USS shows no evidence of an intrauterine pregnancy, a corpus luteum in the left ovary, and otherwise normal adenexae. Her serum b-hCG is 700 (<18 normal range). How should this pregnancy be classified?A 21 y/o woman is 5 weeks pregnant with abdominal pain. USS shows no evidence of an intrauterine pregnancy, a corpus luteum in the left ovary, and otherwise normal adenexae. Her serum b-hCG is 700 (<18 normal range). How should this pregnancy be classified?
PUL
101
A low risk woman would like to have epidural anaesthesia but is concerned about the risks. What is the risk of permanent paralysis (give as 1:X)
1:250,000
102
A 28 y/o woman has a 2 year history of subfertility with oligomenorrhea and PCOS. Her BMI is 32. Her husband’s semen analysis is normal. She has tried a 6 month course of Metformin. What is the most appropriate medication for the treatment of her subfertility?
clomiphene
103
A 31 y/o woman is 37 weeks pregnant and attends GP with itchy rash, though she is systemically well. Temperature 36.8, HR 80, BP 116/78, RR 18, O2 sats 99% on room air. She has the rash depicted below. What is the most likely diagnosis?
polymorphic eruption of pregnancy
104
A 19 y/o woman with intra uterine device in situ presents to GP with new onset low abdominal pain and spotting. Temperature 36.3, HR 83, BP 110/90, RR 18, O2 sats 98% on room air. What is the most appropriate initial investigation?
urine pregnancy test
105
A 34 y/o woman in GP is 28 weeks pregnant. She had normal antenatal screening and scans, and her pregnancy is uncomplicated. She has already had the influenza vaccination. Which other immunisation does she require?
pertussis
106
A 28 y/o woman attends GP requesting emergency contraception 5 days after unprotected intercourse. What is the most effective option available to her?
copper IUD
107
A 38 y/o woman in GP requests contraception. She has severe menorrhagia and had a gastric sleeve bypass 12 months ago. What is the first line contraceptive management in this scenario?
IUS
108
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
109
20 y/o medical student attends A&E on the eve of an exam with difficulty breathing, palpitations, and chest tightness. She says she feels close to collapse, and feels like she is
going to die. This has happened before and she was prescribed Propranolol but this is no longer effective, and she has routinely declined psychological interventions. Routine blood tests, ECG, and CXR are all normal. What is the most appropriate next step in her management?
a. Diazepam
b. Fluoxetine
c. Mirtazapine
d. Risperidone
e. Venlafaxine
diazepam
110
30 y/o white woman is on routine anti-psychotic medication for schizophrenia and has the following blood result:
Hb 140 (normal)
WCC (low)
Platelets 200 (normal)
Neutrophils 1.2 (low)
Lymphocytes 1.3 (normal)
Total cholesterol 5.3 (high)
Total cholesterol: HDL ratio 4.6 (high)
HbA1C 40 (normal)
What medication is she most likely taking?
a. Aripiprazole
b. Clozapine
c. Haloperidol
d. Quetiapine
e. Risperidone
clozapine
111
29 y/o woman admitted to postnatal ward after emergency C-section. Midwife observes she has been acting bizarrely, hasn’t slept all night, and has been pacing up and down the ward. She appears distressed when seen and states her baby looks alien and “isn’t human”. What is the most likely diagnosis?
a. Baby blues
b. Bipolar affective disorder
c. Post-natal depression
d. Post-partum psychosis
e. Schizophrenia
Post-partum psychosis
112
21 y/o woman admitted to psych ward for an acute episode. She has been prescribed Amisulpride for the past 3 weeks and is now worries she is pregnant because she has missed her period, however her pregnancy test is negative. Which blood test should be requested in addition to routine bloods?
a. Luteinising hormone
b. Progesterone
c. Prolactin
d. Thyroid stimulating hormone
e. Triglycerides
prolactin
113
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
Cognitive behavioural therapy
114
. 32 y/o woman in first trimester of pregnancy presents with low mood, difficulty sleeping, and poor concentration at work. A trial of CBT is ineffective. What is the most appropriate next step in management?
a. Interpersonal therapy
b. Psychodynamic psychotherapy
c. Sertraline
d. Venlafaxine
e. Short course of Zopiclone
sertraline
115
51 y/o man with Down syndrome has 6 months of poor self-care, increased aggression, and personality change. Recently he has been getting lost on the walk back from the shops to his house. Temperature 36.5, HR 85, BP 127/89, and urinanalysis is negative. What is the most likely diagnosis?
a. Alzheimer’s disease
b. Delirium
c. Depression
d. Hypothyroidism
e. Psychosis
alzheimer's
116
19 y/o man with 1 day of fever, muscle stiffness, palpitations, and difficulty breathing. He has a history of psychotic depression for which he has been taking Fluoxetine for 6 weeks and Risperidone for 1 week. He is agitated with temperature of 39.8, HR 114, BP 172/89, and RR 30. Chest examination is otherwise clear, and neuro exam is normal except for globally increased tone. Which investigation would be most useful diagnostically? a. CT head
b. ECG
c. EEG
d. Lumbar puncture
e. Serum creatine kinase
CK
117
23 y/o man admitted for 3rd person auditory hallucinations, irritability, and beliefs that his neighbours are watching him. This is the first time he has experienced these symptoms and they have lasted for 3 weeks. What is the most likely diagnosis?
a. Acute and transient psychotic disorder
b. Adjustment disorder
c. Paranoid personality disorder
d. Schizoaffective disorder
e. Schizophrenia
A
118
15 y/o girl in A&E after fainting at school. BMI is 16, she has been restricting calorie intake for 1 year, she exercises every day and feels she is overweight. Which additional feature would be needed for a diagnosis of anorexia nervosa?
a. Bradycardia
b. Fear of gaining weight
c. Laxative abuse
d. Muscle weakness
e. Thinning of hair on head
Fear of gaining weight
119
45 y/o man presents with worsening tremor for a few weeks. Has a history of schizophrenia in remission for which he is taking Haloperidol. There is bilateral tremor and cog-wheel rigidity in upper limbs. What is the most appropriate treatment for his symptoms? a. Co-beneldopa
b. Entacapone
c. Pramipexole
d. Procyclidine hydrochloride
e. Selegiline hydrochloride
procyclidine
120
26 y/o woman with schizophrenia admitted to hospital after intentional paracetamol overdose. On day of discharge she breaks her bedside television because she heard the voice of her deceased grandmother telling her to do it. She wants to go home immediately and refuses to stay in hospital; the medical registrar decides detain her for further assessment. Which section of the Mental Health Act should be used here? a. Section 2
b. Section 4
c. Section 5(2)
d. Section 5(4)
e. Section 136
Section 5(2)
121
84 y/o man presents with gradual deterioration in memory for 3 years. He forgets details of conversations and to attend doctor’s appointments, though he can still manage his finances and cook and clean for himself. He regularly goes to the local shops and never gets lost. Which part of the brain is likely to be affected?
a. Cerebellum
b. Frontal lobe
c. Occipital lobe
d. Parietal lobe
e. Temporal lobe
temporal lobe
122
A 25 y/o man has tried Olanzapine and Haloperidol but continues to experience symptoms of schizophrenia. What is the most appropriate next step in his management? a. Aripirazole
b. Clonazepam
c. Clozapine
d. Lithium
e. Quetiapine
clozapine
123
25 y/o woman has recurrent episodes of sudden onset sweating, dry mouth, “butterflies” in her stomach, difficulty breathing, and fear of impending death. These symptoms have been occurring twice weekly for the past 2 years. What is the most likely diagnosis? a. Dissociative disorder
b. Generalised anxiety disorder
c. Hypochondriasis
d. Panic disorder
e. Somatisation disorder
Panic disorder
124
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
125
53 y/o man with 2 years of low mood, poor concentration, and poor sleep that is now affecting job and family life, and he has become socially reclusive. He had an MI 2 years prior and has T2DM. He is referred for CBT but wants to start medication. Which is the most appropriate first medication?
a. Citalopram
b. Fluoxetine
c. Mirtazapine
d. Sertraline
e. Venlafaxine
Sertraline
126
28 y/o man is given regular medication for BPAD and has also been taking Naproxen for a sports injury. He presents to A&E with ataxia, confusion, and tremor. Which medication has most likely caused his symptoms?
a. Carbamazepine
b. Lithium
c. Olanzapine
d. Sertraline
e. Sodium valproate
Lithium
127
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
128
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
129
40 y/o Eritean veteran has an established diagnosis of PTSD, and describes feelings of anxiety in public spaces and waking up from nightmares in a state of panic. Maximum dose Sertraline and CBT are not helpful, which other treatment should be considered? a. Debriefing
b. ECT
c. EMDR
d. Motivational interviewing
e. Psychodynamic psychotherapy
EMDR
130
45 y/o man is taken to A&E by police who are concerned for his health after being in custody for 20 hours. He is known to consume alcohol to excess, and appears dishevelled, agitated, and is tremulous. Blood tests are unremarkable except for moderately deranged LFTs. What is the most likely diagnosis?
a. Alcohol withdrawal syndrome
b. Alcohol induced hepatitis
c. Hepatic encephalopathy
d. Opioid withdrawal syndrome
e. Wernicke’s encephalopathy
Alcohol withdrawal syndrome
131
35 y/o man brought to A&E by police who found him roaming the streets naked, propositioning women for sex. Which MHA section has been used by police to detain him? a. Section 4
b. Section 5(2)
c. Section 5(4)
d. Section 135
e. Section 136
Section 136
132
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
Inpatient detoxification
133
30 y/o man attends A&E with palpitations, dizziness, and chest pain – he is worried that he has had a heart attack. The chest pain is sharp and variable in location, and he gives a history
of 6 months of low mood following being laid off from work. He has attended multiple local hospitals for several years and has reported a variety of different symptoms including headaches over the right ear, difficulty swallowing, and griping stomach pains, but says “the doctor’s haven’t been able to find out what’s wrong with me”. His ECG is normal. What is the most likely diagnosis?
a. Borderline personality disorder
b. Factitious disorder
c. Generalised anxiety disorder
d. Panic disorder
e. Somatisation disorder
Somatisation disorder
134
A 35 y/o man with Fragile X syndrome lives alone, does voluntary work, and travels independently to familiar places, though he needs help planning travel to new areas. He attended a special needs school and has a carer supporting him by helping him to pay his bills. What is his most likely IQ?
a. 20
b. 40
c. 65
d. 80
e. 110
40
135
45 y/o man believes he is dead and does not exist. He says he feels miserable most of the time, and that his wife left him for another man 5 months ago. He has increased his alcohol intake and now has 3 pints of lager every day, and occasionally smokes cannabis. He has lost 7kg in weight over 3 months. What is the most likely diagnosis?
a. Alcohol induced psychosis
b. Delusional disorder
c. Depressive episode with psychotic symptoms
d. Psychosis secondary to illicit drug use
e. Schizophrenia
Depressive episode with psychotic symptoms
136
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
137
25 y/o woman is brought to A&E after a fight in public where she fractured her hand. She is agitated and blames the other person for the altercation as they cut the queue. She has an extensive history of shoplifting in her teenage years. What is the most likely diagnosis?
a. Antisocial personality disorder
b. Anxious/ avoidant personality disorder
c. Histrionic personality disorder
d. Paranoid personality disorder
e. Schizoid personality disorder
a. Antisocial personality disorder
138
48 y/o man has hypertension, anxiety, gout, and back pain. His routine ECG shows a QT interval of 460ms (380-440 normal range). Which is the most likely causative medication?
a. Allopurinol
b. Amitriptyline
c. Co-codamol
d. Diazepam
e. Ramipril
amitriptylline
139
4 y/o boy seen in GP with his mother because of concerns at school that he does not make friends easily, his speech is limited, and he is often seen on his own lining up Lego bricks by colour. What is the most likely diagnosis?
a. ADHD
b. Autism
c. Global developmental delay
d. Hearing impairment
e. Separation anxiety
Autism
140
37 y/o woman attends GP for anxiety accompanied by her friend. She has been married for 20 years and tearfully tells the GP she cannot cope when he has to work abroad for a couple of months. She is worried about being left alone to fend for herself and that she can’t make everyday decisions without his help. What is the most likely diagnosis?
a. Adjustment disorder
b. Anxious/ avoidant personality disorder
c. Dependent personality disorder
d. Depressive disorder
e. Generalised anxiety disorder
Dependent personality disorder
141
A 29 y/o woman in GP is complaining of palpitations, sweating, dry mouth, and paraesthesia each time she leaves the house. She has a PMHx of asthma. Which is the most appropriate drug class to use?
a. Atypical anti-psychotic
b. Benzodiazepine
c. Beta blocker
d. Sedating antihistamine
e. SSRI
SSRI
142
38 y/o woman in GP has 8 months of amenorrhea on a background of T2DM and BPAD. Her pregnancy test is negative. Investigations:
Luteal LH 2.0 (normal)
Luteal FSH 2.0 (normal)
TSH 2.3 (normal)
Testosterone 1.0 (normal)
SHBG 80.0 (normal)
Prolactin 821 (high)
Which medication is most likely to have caused this?
a. Diazepam
b. Metformin
c. Risperidone
d. Sertraline
e. Zopiclone
risperidone
143
70 y/o woman known to community mental health team sees her GP with new onset tremor, painful muscle contractions, dry mouth, and weight gain. Which medication is likely to be causing her symptoms?
a. Amitriptyline
b. Levodopa
c. Olanzapine
d. Paroxetine
e. Propranolol
Olanzapine
144
28 y/o woman attends GP for 6 week post-natal check following emergency C-section. She is feeling tired, low in energy, has poor appetite, and is having some frightening thoughts or about hurting her baby. Which is the most likely diagnosis?
a. Adjustment disorder
b. Baby blues
c. PTSD
d. Post-natal depression
e. Puerperal psychosis
Post-natal depression
145
73 y/o man in GP is distressed after his husband died 6 weeks ago. He has reduced appetite, trouble sleeping, and poor concentration. He questions whether life is worth living but has no active suicidal ideation. He still enjoys spending time with his grandchildren. What is the most likely diagnosis?
a. Generalised anxiety disorder
b. Moderate depressive disorder
c. Normal grief reaction
d. Persistent prolonged bereavement disorder
e. Prolonged grief disorder
Normal grief reaction
146
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
147
40 y/o man was punched in the face by his new partner and sustained a broken jaw 1 week ago. He now presents with panic attacks, nightmares, and suicidal thoughts. He ruminates about the incident and is unable to concentrate at work. What is the most likely diagnosis? a. Acute stress reaction
b. Adjustment disorder
c. Depressive episode
d. Obsessive compulsive disorder
e. PTSD
acute stress reaction
148
. 20 y/o woman presents to A&E with agitation, confusion, high temperature, sweating, muscle twitches, and diarrhoea. She was recently started on medication for depression. What is the most likely diagnosis?
serotonin syndrome
149
60 y/o man with schizophrenia is taking haloperidol and has developed uncontrolled repetitive movements of his jaw with grimacing and protrusion of his tongue. What phenomenon is this?
tardive dyskinesia
150
97 y/o woman has dementia and frequently tries to leave her nursing home an 03:00 in her nightgown to feed the swans. What legal framework may be considered in order to prevent her from leaving?
deprivation of liberty safeguards
151
55 y/o woman presents to A&E after taking an overdose of 6 paracetamol tablets following a relationship breakdown. She states her life is not worth living and she feels empty inside. She has numerous scars on her forearms. She has attended A&E 7 times this year with a similar presentation. What is the most likely diagnosis?
EUPD
152
. 27 y/o woman reviewed by community mental health team for schizophrenia follow-up. She describes experiences where she thinks she isn’t real. What phenomenon is this?
depersonalisation
153
55 y/o man admitted to hospital 3 days ago for knee replacement. Now complaining of seeing ants crawling up his legs and appears confused and tremulous. What is the most likely diagnosis?
delirium
154
78 y/o woman has had difficulty planning and with focus for past 6 months. She reports seeing people at her dining table that nobody else can see. What is the most likely diagnosis?
Lewy body dementia
155
11 y/o boy excluded from school following destructive behaviour including arson and aggressive behaviour towards peers. He has repeatedly been cautioned by police for shoplifting. What is the most likely diagnosis?
conduct disorder
156
36 y/o man started on lithium for BPAD. He is scheduled to have regular monitoring of lithium levels, renal function, calcium, and glucose. Which other blood test should be monitored?
TFTs
157
50 y/o man believes wife is cheating on him, gathering evidence by repeated obsessive examination of her underwear. What is the most likely psychiatric diagnosis?
othello syndrome
158
40 y/o woman attends A&E after her mother’s funeral with sudden onset blindness, but seems largely unconcerned about this new development. Physical examination and investigations are normal. What is the most likely disorder?
conversion disorder
159
87 y/o woman with indwelling catheter presents with sudden onset agitation and visual hallucinations. What is the most likely diagnosis?
delirium
160
20 y/o man with schizophrenia tells his support worker that the TV news presenter talks about him. What psychotic phenomenon is he describing?
delusion of reference
161
56 y/o man brought to A&E by ambulance after he’s found collapsed in a park. His pupils are constricted and his RR is 6. Which mediation should be urgently administered?
naloxone
162
. 78 y/o woman has 2 weeks of progressive lethargy, nausea, and dizziness. She has depression and has recently increased her dose of Citalopram. What is the most likely biochemical abnormality?
hyponatraemia
163
22 y/o female with diagnosis of OCD presents to her GP for a repeat prescription of her medication. Which class of drug is first line for OCD?
SELECTIVE SEROTONIN REUPTAKE INHIBITOR
164
40 y/o doctor has central chest pain but a normal ECG. 3 months ag he attended rapid access chest pain clinic but was discharged after normal exercise stress test. His only PMHx is chronic rhinitis. What is the most likely drug of abuse in this case?
COCAINE
165
