SPECIALTIES 2023 Flashcards by Danea Saad

Lady attends 34-week GP appointment, G2P1. Booking blood pressure was 118/91, today her blood pressure is 145/95. Urine dip: protein –ve, nitrite –ve, glucose –ve. What is the next step in her management?

Start nifedipine
reassure and continue routine antenatal appointment
same day antenatal triage

same day antenatal triage

How well did you know this?

Not at all

Perfectly

Woman in her 60s, figure of eight white itchy skin outside introitus
Lichen sclerosus
Lichen planus
Simplex

Lichen sclerosus

How well did you know this?

Not at all

Perfectly

Woman needing HRT. Had previous Oestrogen receptor positive breast cancer with mastectomy.

SSRI

How well did you know this?

Not at all

Perfectly

Woman experiencing vasomotor symptoms. Doesn’t like sertraline. Previous history of breast cancer.
Acupuncture
continuous combined HRT
cyclical combined HRT
CBT

CBT

How well did you know this?

Not at all

Perfectly

Woman with breast pain, 2cm abscess.
Drain abscess and send off for culture
prescribe amoxicillin and advise to continue breastfeeding
prescribe amox and stop breastfeeding

Drain abscess and send off for culture

How well did you know this?

Not at all

Perfectly

Woman with previous VTE in pregnancy, currently 12 weeks pregnant. At what point in her pregnancy should she start VTE prophylaxis?
12 weeks
20 weeks
24 weeks

12 weeks

How well did you know this?

Not at all

Perfectly

Lady smoking 20 cigarettes a day, what is most likely to happen during her pregnancy?
IUGR - intrauterine growth restriction
Pre-eclampsia

IUGR

How well did you know this?

Not at all

Perfectly

A 33 year old woman presents with a pelvic mass and pressure symptoms affecting her bladder. She is nulliparous. An ultrasound shows multiple fibroids, the largest being an anterior subserosal fibroid, measuring 8 cm. Which is the most appropriate management?
☐ A. Hysterectomy
☐ B. Myomectomy
☐ C. Progestogen containing intrauterine. system
☐ D. Progestogen only pill
☐ E. Uterine artery embolisation

Myomectomy

How well did you know this?

Not at all

Perfectly

A 35 year old woman is in spontaneous labour. She has had a long first and second stage of labour. The head delivers slowly and the chin is not visible. The midwife has pulled the emergency buzzer. Which is the most appropriate next step in management?
☐ A. All fours
☐ B. Episiotomy
☐ C. Flatten the bed
☐ D. McRobert’s manoeuvre
☐ E. Posterior arm

Flatten the bed

How well did you know this?

Not at all

Perfectly

28 year old woman in the Emergency Department has 4 hours of worsening, intermittent left iliac fossa pain. It is associated with vomiting and dizziness.
Which is the most appropriate initial investigation?
☐ A. CRP
☐ B. Full blood count
☐ C. Pelvic ultrasound
☐ D. Urine dipstick
☐ E. Urine pregnancy test

Urine pregnancy test

How well did you know this?

Not at all

Perfectly

A 35 year old woman delivered her first baby 3 days ago by forceps with an episiotomy. She is tearful and emotionally labile.
Which is the most likely diagnosis?
☐ A. Baby blues
☐ B. Bipolar affective disorder
☐ C. Post traumatic stress disorder
☐ D. Postnatal depression
☐ E. Puerperal psychosis

Baby blues

How well did you know this?

Not at all

Perfectly

25 year old woman in the antenatal clinic at 14 weeks gestation has Type 2 female genital mutilation.
Who should be notified as the first point of contact?
☐ A. Consultant obstetrician
☐ B. GP
☐ C. Paediatric safeguarding team
☐ D. Police
☐ E. Safeguarding midwife

Safeguarding midwife

How well did you know this?

Not at all

Perfectly

A 57 year old woman in rapid access clinic has had two episodes of post menopausal bleeding. A transvaginal ultrasound scan 2 weeks ago shows a 3 cm simple left ovarian cyst and an endometrial thickness of 6 mm.
Which is the next most appropriate investigation?
☐ A. Diagnostic laparoscopy
☐ B. Pipelle biopsy
☐ C. Refer for hysteroscopy
☐ D. Repeat transvaginal ultrasound scan
☐ E. Serum Ca-125

Pipelle biopsy

How well did you know this?

Not at all

Perfectly

A 30 year old woman had a forceps delivery 8 hours ago following prolonged rupture of membranes. Her temperature is 38.8°C, pulse rate 110 bpm, BP 98/54 mmHg, respiratory rate 20 breaths per minutes and oxygen saturations 92% breathing air.
Which is the next most appropriate step in management?
☐ A. High flow oxygen
☐ B. Intravenous antibiotics
☐ C. Intravenous fluids
☐ D. Perform septic screen
☐ E. Urinary catheterisation

High flow oxygen

How well did you know this?

Not at all

Perfectly

2
A 36 year old woman with a BMI of 24 kg/m [18.5-25] has had an elective caesarean section for breech presentation.
Which is the most appropriate prophylaxis for venous thromboembolism whilst in hospital?
☐ A. Aspirin 75mg once daily
☐ B. Asprin 75mg once daily and thromboembolic deterrent stockings
☐ C. Low molecular weight heparin
☐ D. Thromboembolic deterrent stockings
☐ E. Thromboembolic deterrent stockings and low molecular weight heparin

Thromboembolic deterrent stockings and low molecular weight heparin

How well did you know this?

Not at all

Perfectly

A 24 year old woman has an antepartum haemorrhage at 27+2 weeks gestation. She has soaked one pad and the bleeding has now stopped. The fetal heart has been auscultated. Her blood group is B Rhesus negative. Her temperature is 36.6°C, pulse 72 bpm, BP 110/70 mmHg, respiratory rate 16 breaths per minute, oxygen saturations 99% breathing air.
Which is the next most appropriate management step?
☐ A. Give anti D at 28 weeks gestation
☐ B. Give anti D immediately
☐ C. Give anti D postnatally
☐ D. Perform a Kleihauer test and give anti D immediately
☐ E. Perform a Kleihauer test and give anti D postnatally

Perform a Kleihauer test and give anti D immediately

How well did you know this?

Not at all

Perfectly

A couple in their mid-twenties have been trying to conceive for 2 years. The male partner has been diagnosed with azoospermia.
Which is the most likely cause of azoospermia?
☐ A. Chlamydia
☐ B. Gonorrhoea
☐ C. Mumps orchitis
☐ D. Undescended testis
☐ E. Varicocoele

Mumps orchitis

How well did you know this?

Not at all

Perfectly

A 26 year old woman at 9 weeks gestation attends midwife antenatal clinic for her booking bloods.
Which is the routine screening blood test for Hepatitis B infection?
☐ A. Hepatitis B ‘e’ antibody
☐ B. Hepatitis B core antibody
☐ C. Hepatitis B core antigen
☐ D. Hepatitis B surface antibody -
☐ E. Hepatitis B surface antigen

Hepatitis B surface antigen

How well did you know this?

Not at all

Perfectly

A 17 year old girl has severe period pains during the first 2 days of her menstrual cycle since menarche 4 years ago. Her cycles are regular but heavy. She has never been sexually active and she has no other medical problems.
Which is the most likely diagnosis?
☐ A. Endometriosis
☐ B. Ovarian cyst
☐ C. Pelvic inflammatory disease
☐ D. Polycystic ovarian syndrome
☐ E. Primary dysmenorrhoea

Primary dysmenorrhoea

How well did you know this?

Not at all

Perfectly

17 year girl old in General Practice had unprotected sexual intercourse 4 days ago. She wishes to avoid pregnancy.
Which is the most appropriate treatment?
☐ A. Administration of oral levonorgestrel
☐ B. Insertion of a copper intrauterine contraceptive device
☐ C. Insertion of a levonorgestrel intrauterine system
☐ D. Insertion of a subcutaneous progestogen implant
☐ E. Insertion of vaginal contraceptive ring

Insertion of a copper intrauterine contraceptive device

How well did you know this?

Not at all

Perfectly

A 36 year old woman in General Practice has a routine pill check. She has three children and has completed her family. She smokes 5 cigarettes per day. She has been taking the combined contraceptive pill for the past 10 years. Despite this her periods are heavy and last for 8-10 days.
Which is the most appropriate contraceptive option?
☐ A. Advise barrier contraception only
☐ B. Continue on the combined oral contraceptive pill
☐ C. Laparoscopic tubal occlusion
☐ D. The copper intrauterine device
☐ E. The Intrauterine system (Mirena)

The Intrauterine system (Mirena)

How well did you know this?

Not at all

Perfectly

Woman on risperidone. Now has amenorrhoea. All gynae investigations normal. What do you investigate now?

Prolatin levels

How well did you know this?

Not at all

Perfectly

After how many miscarriages are you diagnosed with recurrent miscarriages?

How well did you know this?

Not at all

Perfectly

Girl with PID – fitz hugh curtis and bilateral hydrosalpinx. What is the most common organism?

Chlamydia trachomatis

How well did you know this?

Not at all

Perfectly

At what point (gestational age in weeks), should someone be referred/investigated if they have not yet foetal movement?

24 weeks

A 40 year old woman in her first pregnancy presents at 37 weeks with a breech presentation at a routine antenatal appointment. Ultrasound scan confirms a fundal placenta and an extended breech fetus on the 25th centile. She is keen to avoid a caesarean section. What is the most appropriate obstetric intervention in this scenario?

External cephalic version

A woman at 36 weeks gestation attends maternity triage with itching. She is otherwise well. She has no visible rash. What obstetric condition needs to be excluded?

Intrahepatic cholestasis of pregnancy

A 39 year old woman has a primary genital herpes infection and is taking oral acyclovir. She is 37+6 weeks pregnant. What is the most appropriate mode of delivery in this scenario?

C section

A 55 year old woman has abdominal bloating. A transvaginal ultrasound shows a 5cm simple ovarian cyst. What is the next most appropriate investigation?

CA-125 blood test

What is the most common side-effect of the contraceptive implant? (e.g., Nexplanon)

irregular bleeding

A 51 year old in General Practice has hot flushes, brain fog and low mood. Her last period was 2 years ago. She had breast cancer treated 11 years ago and is in remission. She is not on any regular medication. What is the most appropriate pharmacological management?

SSRI

A 55 year old postmenopausal woman in General Practice has vaginal bleeding. To what gynaecology outpatient service should this patient be referred?

rapid access clinic

A woman has an uncomplicated routine caesarean section for failure to progress in the second stage. At her postnatal appointment with the GP, she reports ongoing lochia and occasional clots. She reports the lochia has an unpleasant smell, unlike her usual period. What is the most likely diagnosis?

endometritis

A 19 year old woman presents to the GP seeking emergency contraception. She had unprotected sexual intercourse 5 days ago. What is the most effective method of emergency contraception in this scenario?

copper IUD

An 18 month old girl has refused to weight bear on her right leg for 3 days. Her mother reports the child has been well. There is no history of trauma. Her temperature is 36.9°C, pulse rate 110 bpm, respiratory rate 24 breaths per minute and oxygen saturation 98% breathing air. An X-ray shows a spiral fracture of the right tibia. The fracture has been stabilised. Which is the most appropriate next step in management? ☐ A. Admit and call police ☐ B. Admit and initiate safeguarding protocol ☐ C. Discharge and notify social services ☐ D. Discharge with analgesia and safety netting advice ☐ E. Discharge with fracture clinic follow up

Admit and initiate safeguarding protocol

A 2 year old girl refuses to weight bear for 3 days. Her mother reports no history of trauma or recent infection. She has bruises and scattered petechiae on the legs and appears pale but º well kept. Her temperature is 36.9 C, pulse rate 110 bpm, respiratory rate 24 breaths per minute and oxygen saturations 97% breathing air. Haemoglobin 80 g/L (110–140) White cell count 32.1 x 10⁹/L (5.0–12.0) Platelets 7 x 10⁹/L (150–400) CRP 4 mg/L (<5) Which is the most likely diagnosis? ☐ A. Acute lymphoblastic leukaemia ☐ B. Non-accidental injury ☐ C. Rickets ☐ D. Septic arthritis ☐ E. Transient synovitis

ALL

3. A baby born at 41+6 weeks gestation through thick meconium is grunting at 3 hours old. He required no resuscitation at birth. He has mild subcostal recession and nasal flaring. His º temperature is 36.8 C, pulse 156 bpm, respiratory rate 72 breaths per minute and oxygen saturations 95% breathing air. Which is the most likely diagnosis? ☐ A. Congenital Diaphragmatic Hernia ☐ B. Congenital pneumonia ☐ C. Meconium Aspiration Syndrome ☐ D. Pneumothorax ☐ E. Transient Tachypnoea of the newborn

Meconium Aspiration Syndrome

A 3 year old girl is struggling with her breathing. She was given a single dose of PO dexamethasone by her GP 12 hours ago for a barking cough. She is happy playing but has º mild stridor. Temperature 37.1 C, pulse 130bpm, respiratory rate 37 breaths per minute and oxygen saturation 97% breathing air. Which is the most appropriate next step in her management? ☐ A. Adrenaline nebuliser ☐ B. High flow oxygen therapy ☐ C. Oral Amoxicillin ☐ D. Oral Dexamethasone ☐ E. Salbutamol inhaler

Oral Dexamethasone

A 3 year old girl has 5 days of fever and a left sided neck lump. The inframandibular lump is 2cm x 2cm and tender. There is no hepatosplenomegaly. Her temperature is 38.5°C, pulse 140bpm, respiratory rate 25 breaths per minute, oxygen saturation 98% breathing air. Hb 112 g/L (110–140) WCC 18 x 10⁹/L (5.0–12.0) Neutrophils 14 x 10⁹/L (1.5–8.0) Platelets 430 x 10⁹/L (150–400) CRP 113 mg/L (<5) Blood Film Toxic left shift and reactive neutrophils Which is the most likely diagnosis? ☐ A. Glandular fever ☐ B. Infected thyroglossal cyst ☐ C. Lymphadenitis ☐ D. Lymphoma ☐ E. Mumps

Lymphadenitis

3 month old boy has 2 days of fever and crying. He is feeding less than normal and has reduced wet nappies. His temperature is 38.0°C, pulse 170bpm, respiratory rate 38 breaths per minute, oxygen saturation 97% breathing air. He has reduced movement of the right leg, chest is clear and the anterior fontanelle is slightly sunken. Urinalysis: normal Which is the most likely diagnosis? ☐ A. Developmental dysplasia of the hip ☐ B. Non accidental injury ☐ C. Osteomyelitis ☐ D. Reactive arthritis ☐ E. Sickle cell crisis

Osteomyelitis

An 8 month old baby has one episode of blood in his stool. He has had several episodes of screaming followed by vomiting overnight. During these screaming episodes, he appears pale and pulls his legs up to his chest. He has previously been well. Which is the most likely diagnosis? ☐ A. Constipation ☐ B. Cow's milk protein allergy ☐ C. Intussusception ☐ D. Pyloric stenosis ☐ E. Volvulus

Intussusception

8 year old girl has strange episodes at school where she experiences odd sensations of smell, followed by periods where she is difficult to communicate with and then falls asleep for up to an hour. On waking she has no memory of any abnormal event. Which is the most likely diagnosis? ☐ A. Absence seizure ☐ B. Atypical migrane ☐ C. Focal seizure ☐ D. Narcolepsy ☐ E. Viral encephalitis

Focal seizure

A 12 year old boy is finding it difficult to leave on time for school in the mornings. He is washing his hands repeatedly, because he feels they are dirty and folding his pyjamas incessantly until perfect. On several occasions he has described a voice that comes from inside his head and tells him to repeat things over and over again. Which is the most likely diagnosis? ☐ A. Autism spectrum disorder ☐ B. Conduct disorder ☐ C. Generalised anxiety disorder ☐ D. Health anxiety disorder ☐ E. Obsessive compulsive disorder

Obsessive compulsive disorder

A 4 year old boy with asthma has an acute exacerbation. He is receiving oxygen, and has been treated with inhaled salbutamol and hydrocortisone. The chest is quiet on auscultation. o His temperature is 37.5 C, pulse rate 130 bpm, BP 90/50 mmHg, respiratory rate is 60 breaths per minute and oxygen saturations 92% on 15 L/min of oxygen. Which is the most appropriate next step in his management? ☐ A. Atrovent nebuliser ☐ B. Call for senior support ☐ C. Fluid bolus of 20ml/kg ☐ D. Intramuscular adrenaline ☐ E. Intravenous antibiotics

Call for senior support

3 year old is seen in the community paediatric clinic with concerns about his development. His parents report that he started to walk at 19 months old. He has 50 words, can put two word phrases together, has just learned how to sort shapes and builds a five brick tower. His physical examination reveals normal growth and appearance. There is no relevant perinatal or family history. Which is the most appropriate diagnostic investigation? ☐ A. Chromosome analysis ☐ B. Detailed developmental assessment ☐ C. Hearing test ☐ D. No investigation needed ☐ E. Thyroid function tests

Detailed developmental assessment

A 20 month old boy has been off food, irritable and feverish for 5 days. His mother states he has red lips and swollen hands. He has been fully immunised and has no previous illnesses. He has no recent unwell contacts. Investigations show a neutrophil leukocytosis and raised acute phase markers. Which is the most appropriate intravenous medication to administer? ☐ A. Corticosteroids ☐ B. Gamma globulin ☐ C. Interferon alpha ☐ D. Penicillin ☐ E. Sodium chloride 0.9%

Gamma globulin

Child with asthma, sats 90, speaking in full sentences though? Already given oxygen, what do you give them?

Salbutamol Nebulised and Ipratropium Bromide Nebulised

5 year old girl with non-blanching rash after runny nose and fever. What do you give ?

Administer Intramuscular (IM) or Intravenous (IV) Antibiotics – Ceftriaxone or Benzylpenicillin

Neonate with yellow stuff coming out of the right eye, mum had spontaneous vaginal delivery, normal pregnancy, no problems.

Taking a swab for culture and sensitivity to identify the causative organism. Starting empirical treatment with topical antibiotics such as chloramphenico

Another kid with yellow stuff coming out of eye + red eye coming to GP

Chloramphenicol eye drops

X ray showing Double Bubble

duodenal atresia

Question about definitive investigation for pyloric stenosis?

Abdominal Ultrasound

3 years old refusing to stand. High CK and high ESR

Duchenne Muscular Dystrophy (DMD)

Kid with perianal itch. What is the treatment?

Mebendazole

Child with abdominal pain and is pale. Mum has T1DM. Investigations showed: Low Hb, and faltering growth? Management: Gluten free diet growth hormone injections some other stuff

Gluten free diet

Shown a picture of otitis externa. Management? Acetic acid drops oral flucloxacillin dexamethasone drops

Acetic acid drops

13 yr old boy with a lump under one nipple. Given a growth chart which shows he is growing fine. What is likely dx -

Pubertal Gynecomastia

A 3 year old boy has a unilateral blood stained nasal discharge with crusting. Which is the most likely cause? ☐ A. Allergic rhinitis ☐ B. Diphtheria ☐ C. Foreign body ☐ D. Maxillary sinus cancer ☐ E. Nasal polyp

Foreign body

A 4 month old girl in General Practice attends for her third dose of primary immunisations. Which is an absolute contraindication to administering the vaccines? ☐ A. Erythema extending 4cm x 2cm around injection site following her last DTaP immunisation ☐ B. History of confirmed pertussis infection at 6 weeks of age ☐ C. History of febrile convulsions in her 2 year old brother ☐ D. Intercurrent illness with temperature of 38.4 C ☐ E. Severe cows' milk protein intolerance

Intercurrent illness with temperature of 38.4 C

A 3 year old girl in General Practice has a painless limp. The limp has been noticeable intermittently for months. Which is the most likely diagnosis? ☐ A. Developmental dysplasia of the hip ☐ B. Irritable hip ☐ C. Juvenile idiopathic arthritis ☐ D. Perthes' disease ☐ E. Slipped upper femoral epiphysis

Perthes' disease

2 day old term baby is jaundiced. Serum bilirubin level is 300 micromols/L. Baby's blood group is AB negative, mother's blood group is O positive and direct antiglobulin test is 3+. What is the underlying diagnosis?

ABO Incompatibility

4 week old baby girl in the Emergency Department has fever and apnoeas. Her father recently had a cold sore. In addition to IV antibiotics, what is the most appropriate initial pharmacological treatment?

Intravenous Acyclovir

14 year old boy has 2 months of bloody diarrhoea, weight loss and mouth ulcers. What non-invasive test would support the diagnosis of this condition?

Fecal Calprotectin

5 day old breast fed baby boy has jaundice. He was born at term, is feeding well and gaining weight. What is the most likely diagnosis?

Physiological Jaundice

A ‘clunk' is felt when examining the hips of a 48 hour old baby, as part of a routine baby check. What is the most likely diagnosis?

Developmental Dysplasia of the Hip (DDH)

3 year old boy has bilateral puffy eyes. He had a recent upper respiratory tract infection. His trousers feel tight around his waist and his parents report fewer wet nappies. This has developed gradually over the past few weeks. He has swelling around his ankles, sacrum and scrotum. What bedside test will be diagnostic in this scenario?

Urine dipstick

A 3 year old boy has a chronic limp. His hip X-ray is shown in the image. What is the most likely diagnosis?

DDH

At newborn check a baby is noted to have wide sandal gap, a single palmar crease and slanted eyes. What chromosome is most likely to be affected?

Chromosome 21

10 year old boy in General Practice has started wetting the bed at night, having previously been dry since age four. He has tried star charts and bedwetting alarms. What is the most appropriate medication to trial?

Desmopressin

Guy is in a car crash 2 weeks ago, avoids driving, can’t sleep

acute stress reaction

Veteran who saw his colleagues be killed. Can’t sleep, flashbacks

PTSD

Woman who thinks she’s bleeding internally every time she gets her periods, but all investigations normal Hypochondriacal disorder, conversion disorder, malingering, somatisation

Hypochondriacal disorder

Recurrent abdo pain, leg pain Hypochondriacal disorder, conversion disorder, malingering, somatisation

somatisation

Woman coming to GP, has previously diagnosis of bipolar, but has had stable mood for many years. Now in early pregnancy, what to do next? Reassure her and advise to seek help from GP if she becomes unwell; reassure and advise to attend antenatal appointments; refer to perinatal MH team

refer to perinatal MH team

Guy on quetiapine. Long QT. What do you do Repeat ecg, stop the drug

Repeat ecg

Man who is described as ‘loner’ by colleagues and works night shifts organising catalogues. No friends. Has eccentric thoughts

schizotypal

Man with previous MI who is depressed. Low appetite and poor sleep. Has had sertraline in past and doesn’t want another SSRI - what medication do you give?

mirtazapine

Man who weighs himself 2 times a day and records it. Has not lost weight. Does not use laxatives. Thinks he has cancer? OCD, Body Dysmorphia, Hypochondriasis, Somatisation, Conversion

Hypochondriasis

32 year old woman with bipolar affective disorder is 20 weeks pregnant. She is referred to the perinatal psychiatry team for a review of her medication. She is taking sodium valproate. Which congenital malformation is the most relevant concern to highlight to her? ☐ A. Cleft palate ☐ B. Ebstein's anomaly ☐ C. Hypospadia ☐ D. Neural tube defects ☐ E. Patent foramen ovale

Neural tube defects

An 80 year old woman in the Emergency Department is agitated and suspicious. She has dementia. Her daughter reports a recent change in behaviour after starting a new medication 4 days ago. Which medication is she most likely to have been prescribed? ☐ A. Atorvastatin ☐ B. Calcium carbonate tablets (Calcichew) ☐ C. Digoxin ☐ D. Donepezil ☐ E. Prednisolone

Prednisolone

74 year old woman with a 2 month history of low mood and social withdrawal is admitted to the mental health unit. For the past 3 days, she has not been responding to staff when they interact with her. She has rigidity in her arms and legs and when you lift her arm up, it does not return to its original position. Which rating scale would help you make a diagnosis in this patient? ☐ A. Becks Depression Inventory ☐ B. Bush-Francis Catatonia Scale ☐ C. Confusion Assessment Method ☐ D. Hospital Anxiety & Depression Scale ☐ E. Patient Health Questionnaire-9

Bush-Francis Catatonia Scale

68 year old woman with treatment resistant depressive disorder has catatonia. She has had memory impairment for 6 months. She has a history of diabetes, asthma and deranged renal function. She had a myocardial infarction 3 weeks ago. Which of her comorbidities would be a relative contraindication for ECT? ☐ A. Asthma ☐ B. Catatonia ☐ C. Deranged renal function ☐ D. Memory impairment ☐ E. Recent myocardial infarction

Recent myocardial infarction

17 year old girl in the Emergency Department has palpitations and muscle cramps. She feels weak and fatigued. She has a history of purging and has recently lost a significant amount of weight. Her ECG reveals T-wave inversion. Which electrolyte abnormality is most likely to cause this presentation? ☐ A. Hypercalcemia ☐ B. Hyperkalaemia ☐ C. Hypernatremia ☐ D. Hypokalaemia ☐ E. Hypophosphatemia

Hypokalaemia

10 year old girl is referred to CAMHS by her school as she has been struggling with school work and exhibiting disruptive behaviour. An IQ test (WICS-V) is completed and her Full Scale Intelligence Quotient (FSIQ) score is 55. Which is the level of impairment that best describes this outcome? ☐ A. Average ☐ B. Borderline ☐ C. Extremely low ☐ D. Low average ☐ E. Very low

Extremely low

A 46 year old male inpatient has recently been initiated on clozapine following relapse of paranoid schizophrenia. He reports chest pain and tachycardia. ECG demonstrates ST elevation. Which is the most likely diagnosis? ☐ A. Acute coronary syndrome ☐ B. Acute heart failure ☐ C. Myocarditis ☐ D. Pleural effusion ☐ E. Pulmonary embolism

Myocarditis

A 64 year old man in the psychiatry outpatient clinic has unexplained lower back pain. He has been thoroughly investigated and no organic disorder diagnosed. The pain started 6 months ago when he was fired from his job. He has a history of painful joints and limbs with no formal diagnosis made. Which is the most likely diagnosis? ☐ A. Conversion disorder ☐ B. Factitious disorder ☐ C. Hypochondriacal disorder ☐ D. Malingering ☐ E. Somatisation disorder

Somatisation disorder

11 year old boy has restlessness and difficulties with concentration for the past 5 years. His school teacher reports that he is frequently disruptive in class. His mother reports that he always crosses the road without looking properly. Which is the most likely diagnosis? ☐ A. Attention deficit hyperactivity disorder ☐ B. Autism spectrum disorder ☐ C. Conduct disorder ☐ D. Dissociative disorder ☐ E. Personality disorder

Attention deficit hyperactivity disorder

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? ☐ A. Allow her to self-discharge ☐ B. Detain her under the Deprivation of Liberty Safeguards ☐ C. Detain her under the Mental Capacity Act ☐ D. Detain her under the Section 2 of the Mental Health Act ☐ E. Detain her under the Section 5(2) of the Mental Health Act

Detain her under the Section 5(2) of the Mental Health Act

30 year old man is training to be a body builder. His wife is concerned about changes in his behaviour. His sleep is disturbed and his mood fluctuates. He has been talking to himself and seems preoccupied with internal phenomena. Which is the most likely diagnosis? ☐ A. Bipolar affective disorder ☐ B. Depressive disorder ☐ C. Hormonally-induced mood swings ☐ D. Personality disorder ☐ E. Steroid-induced psychotic disorder

Steroid-induced psychotic disorder

A 22 year old lady with schizophrenia has recently had the dose of her depot antipsychotic increased. She is unwell with rigidity, urinary incontinence and altered consciousness. Her temperature is 39°C, pulse rate 120 bpm, BP 120/80 mmHg, respiratory rate 20 breaths per minute and oxygen saturation 98% breathing air. Which is the most likely diagnosis? ☐ A. Neuroleptic malignant syndrome ☐ B. Parkinson's disease ☐ C. Sepsis ☐ D. Serotonin syndrome ☐ E. Vasovagal syncope

Neuroleptic malignant syndrome

32 year old woman gave birth to a baby boy 5 days ago. She is very tearful and is having difficulty feeding her baby. Which is the most appropriate intervention? ☐ A. Admit to a mother and baby unit ☐ B. Offer an antidepressant ☐ C. Provide advice / reassurance and offer follow up within the next week ☐ D. Refer to a parenting class ☐ E. Refer to the home treatment (crisis resolution) team

Provide advice / reassurance and offer follow up within the next week

A patient is on prophylactic treatment with Lithium. Assuming that the patient has no side-effects from the treatment, which blood tests are required for regular monitoring? ☐ A. Lithium levels ☐ B. Lithium levels, liver function tests, full blood count ☐ C. Lithium levels, liver function tests, thyroid function tests ☐ D. Lithium levels, urea and electrolytes, thyroid function tests ☐ E. None, unless symptoms or side-effects develop

Lithium levels, urea and electrolytes, thyroid function tests

A 38 year old woman in General Practice has 3 months of hopelessness, tearfulness and low self-esteem. She struggles to get out of bed in the mornings and has difficulty concentrating at work. Which is the most appropriate score to assess this patient? ☐ A. AMTS ☐ B. GAD score ☐ C. HAD scale ☐ D. PHQ-9 ☐ E. PUQE

PHQ-9

A 44 year old man tells his GP that he has been troubled with recurrent mental images of child pornography. He feels deeply anxious about this and is requesting help. Which is the most likely diagnosis? ☐ A. Anankastic (obsessive compulsive) personality disorder ☐ B. Generalised anxiety disorder ☐ C. Obsessive compulsive disorder ☐ D. Paedophilia ☐ E. Paranoid schizophrenia

Obsessive compulsive disorder

A 19 year old woman in General Practice has weight loss, apathy and poor self-care for 2 months. She dropped out of university soon after starting her course, and now spends most of her time in her room playing music. Her mother brought her to the GP and she is suspicious and reluctant to talk during the consultation. She recently accused her mother of trying to poison her. Which is the most likely diagnosis? ☐ A. Acute psychotic disorder ☐ B. Autism ☐ C. Depression ☐ D. Eating disorder ☐ E. Personality disorder

Acute psychotic disorder

50 year old woman in psychiatry outpatient clinic has nausea and diarrhoea. She has bipolar affective disorder. On examination, she has a mild hand tremor when she extends her arms. She recently started taking a new medication to manage her mood. What medication is she likely to be taking?

lithium

A 23 year old man with paranoid schizophrenia is admitted to hospital with confusion. His temperature is 38.5°C, pulse rate 110 bpm, BP 150/90, respiratory rate 22 breaths per minute and oxygen saturation 95% breathing air. He has recently been initiated on haloperidol and the dose was being increased over a 1 week period. What is his most likely diagnosis?

Neuroleptic Malignant Syndrome (NMS)

7 year old woman in the urgent care centre has dizziness, irregular periods and hair loss. She admits to intentional weight loss and exercising excessively. What is the most likely diagnosis?

Anorexia Nervosa

35 year old man in the Emergency Department has confusion, slurred speech and an unsteady gait. His temperature is 36.5°C, pulse rate 100 bpm, BP 110/75, respiratory rate 13 breaths per minute and oxygen saturation 95% breathing air. He has difficulty breathing. He admits to taking tablets given to him by a friend to help his anxiety. What class of medication is he likely to have taken?

Benzodiazepines

54 year old man is brought to the Emergency Department by ambulance having been found collapsed and confused in the town centre by a passerby. He is ataxic but he resists more detailed neurological examination. ALT is 56 IU/L (10–50) but blood tests are otherwise unremarkable. What medication is most appropriate to administer to him?

Thiamine

. A 21 year old university student closely monitors her calorie intake and has started taking 2 laxatives daily. Her BMI is 24.5 kg/m . What is the most likely diagnosis?

Bulimia Nervosa

SPECIALTIES 2023 Flashcards

(101 cards)