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Paediatrics
Penelope is a 15 month old NZ European female brought into your GP clinic by her father with noisy breathing overnight and this morning. She has had a cold for the past day from her older brother. On examination she has inspiratory and expiratory stridor, and retractions between her ribs visible at rest. She looks quite tired. There is no sign of cyanosis. Which of the following would be most appropriate?
A) Stat dexamethasone 0.15mg/kg and monitor for 1 hour
B) Stat dose prednisolone 1mg/kg and arrange hospital transfer
C) Stat dose dexamethasone 0.6mg/kg and monitor for the next 2 hours
D) Advice humidification ie. rest in a steamy room
E) Paracetamol and ibuprofen regularly and monitor breathing
Mental health
Rangi is a 31 year old Māori male who has just separated from his partner in the past 3 weeks, and it is especially difficult with now organising shared custody of their kids. He is feeling down, struggling to concentrate at work, and not sleeping well at all. He denies any thoughts of self harm. A depression assessment tool indicates mild severity. Which of the following statements regarding mental health in Māori is not true?
A) Māori in rural and urban areas have similar levels of mental health conditions
B) There is no evidence that Māori are genetically predisposed to mental health conditions
C) Higher rates of hospitalisation from mental health are usually due to poor medication compliance when compared to total population
D) Depression and anxiety rates among Māori are as high, or higher, than in the total population
E) All of the above
Men's health
Angelo is a 42 year old man who comes in to see you in the acute clinic feeling nauseous and fatigued. He has been feeling unwell for three days. He has been medicating with paracetamol and ibuprofen. In addition to the above symptoms he has dysuria and some pelvic pain. On examination he has a temperature of 37.1 degrees celsius, heart rate of 86, blood pressure of 128/80. Abdominal examination shows tenderness in the suprapubic area but no renal angle tenderness. Genital examination is unremarkable except for some tenderness in the perineal region. The patient declined to have a digital rectal examination. Given the most likely diagnosis how would you initially treat this patient?
A) Trimethoprim 300mg OD for 14 days
B) ED referral
U) Urology referral
D) Cefalexin 500mg BD for 3 days
E) Doxycycline 100mg BD for 21 days
Surgery
Simone is a 42 year old woman who comes to see you 3 years post Roux-en-y surgery for follow up. Since the surgery she is compliant with dietary changes and has lost 45kg, with a current weight of 84kg. Her hypertension and type 2 diabetes have resolved and she is no longer taking any medication except those prescribed by the bariatric surgeon. Which of the following is not a routine consideration at annual review following discharge from surgical services?
A) Thyroid function tests
B) Vitamin D
C) Iron, B12 and folate levels
D) Full blood count
E) Liver function
Answers:
Paediatric case = B Mental health = C Mens health = A Surgery = A