Wentwest SGPe 1: Applied Knowledge Test Paper

The most likely diagnosis in this case is acute pancreatitis. The patient's sudden onset of upper abdominal pain radiating through to the back, associated with vomiting, and different from his usual biliary colic attacks, along with upper abdominal tenderness on examination, are all consistent with acute pancreatitis. This condition is commonly associated with gallstones and can cause severe abdominal pain. Other options such as hiatus hernia, gastroenteritis, abdominal aortic aneurysm, and coeliac disease are less likely based on the given information.

Morton's symptoms of increasing pain in his calves on walking, poor peripheral pulses, and sluggish capillary return are consistent with peripheral vascular disease (PVD). PVD refers to the narrowing or blockage of blood vessels that supply blood to the legs and arms. This can cause pain, especially during physical activity, due to reduced blood flow to the muscles. The other options, such as DVTs, spinal canal stenosis, multiple myeloma, and age-related changes, are less likely to cause these specific symptoms.

The most likely diagnosis for Graham's painful swelling behind his knee is a ruptured Baker's cyst. This is supported by the tenderness and erythema in the popliteal fossa, which is the area where the Baker's cyst is located. A Baker's cyst is a fluid-filled sac that forms behind the knee due to excess synovial fluid from the knee joint. When the cyst ruptures, it can cause pain and swelling in the area.

The most likely diagnosis for Jonathan's rash on his leg is cellulitis. Cellulitis is a bacterial skin infection that typically presents with redness, warmth, swelling, and pain. It can develop over a few days and is often associated with a break in the skin, such as a cut or scratch. The picture below is not provided, but based on the given information of a rash that developed over the last 3 days, cellulitis is the most fitting diagnosis.

The patient's symptoms of weight loss, night sweats, cough with occasional haemoptysis, and physical examination findings of erythema nodosum, reduced air entry, and dullness to percussion suggest a diagnosis of tuberculosis. Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis and commonly presents with these symptoms. The absence of risk factors for HIV and the specific findings on examination point towards tuberculosis as the likely diagnosis. Pneumocystis carinii pneumonia is more commonly seen in immunocompromised individuals, bronchopneumonia does not explain the specific findings, lung cancer typically presents differently, and sarcoidosis may have similar symptoms but does not usually present with erythema nodosum.

The most appropriate advice for Amanda is to use nonsteroidal agents during exacerbations of pain. This suggestion is based on the information provided in the question, which states that Amanda has a 5-year history of increasingly painful periods and more recent deep dyspareunia. Nonsteroidal agents are commonly used to manage pain associated with conditions such as dysmenorrhea and endometriosis, which could be the underlying causes of Amanda's symptoms. This advice aims to provide relief during episodes of increased pain.

The correct diagnosis in this case is a chalazion. A chalazion is a painless bump or swelling on the eyelid that occurs when a meibomian gland becomes blocked or inflamed. It usually develops slowly and may be accompanied by redness and swelling. It is a benign condition and can often be treated with warm compresses and gentle massage. In some cases, it may require medical intervention such as steroid injections or surgical drainage.

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Maggie's symptoms of needing to go to the toilet quickly and being incontinent suggest a loss of bladder control, which is characteristic of urge incontinence. This condition is often caused by an overactive bladder muscle, leading to sudden and strong urges to urinate. It can be disruptive to daily life and can interfere with work, as seen in Maggie's case. Other potential diagnoses, such as stress incontinence or urinary tract infection, may also cause similar symptoms, but the urgency and frequency of urination point towards urge incontinence as the most likely diagnosis.

Fluconazole is contraindicated in pregnancy because it is classified as a category D medication by the FDA. Category D medications have shown evidence of risk to the fetus in human studies. Fluconazole has been associated with an increased risk of birth defects, including skeletal abnormalities and craniofacial malformations, when used during the first trimester of pregnancy. Therefore, it should be avoided in pregnant women unless the potential benefits outweigh the risks.

Given the patient's history of a fall and the acute swelling and difficulty flexing the knee, it suggests the possibility of an intra-articular fracture with a haemarthrosis. Haemarthrosis refers to bleeding into a joint cavity, which can occur with fractures. This is a likely explanation for the symptoms and should be considered as a possible diagnosis for this patient.

Given the patient's age and history of starting periods again after being off HRT for 4 years, it is important to rule out any underlying gynecological pathology. Referring the patient for a gynecologist review is the most appropriate next step in management to assess and address any potential issues related to her menstrual cycle.

The most likely diagnosis for Domengo's symptoms is scabies. Scabies is a contagious skin condition caused by a mite called Sarcoptes scabiei. It is characterized by intense itching, particularly at night, and the presence of scratch marks and papules with raised white lines on the skin. Domengo's recent arrival in Australia and his foreign student status may have exposed him to the mite in a new environment. The other options, such as Pemphigus, Pompholyx, Dermatitis artefacta, and IgE hypersensitivity, do not match the specific symptoms and presentation described.

Raynaud's phenomenon is a condition characterized by episodes of reduced blood flow to the fingers and toes, causing them to turn white, blue, and then red. It is often triggered by cold temperatures or emotional stress. The characteristic facial appearance seen in Evette may indicate that she has a connective tissue disorder such as systemic sclerosis, which is commonly associated with Raynaud's phenomenon. Therefore, it would be expected to see Raynaud's phenomenon associated with this disease.

The most appropriate next investigation to order would be to measure FSH (follicle-stimulating hormone) and testosterone levels. John's symptoms of low libido, lethargy, weakness, and decreased facial hair suggest possible hormonal imbalances. Measuring FSH and testosterone levels can help assess if there is an issue with the production or regulation of these hormones, which could be contributing to his symptoms. This investigation would provide valuable information for further evaluation and management of his condition.

Max's symptoms, including the inability to pass urine, a tender bladder, and a history of dysuria, suggest urinary retention. The most likely cause of this is a urinary tract infection (UTI). The appropriate management in this case would be to insert an indwelling catheter to relieve the urinary retention. This would help to drain the bladder and treat the underlying UTI.

Wax impaction may be the result of hearing aid use. This is the most appropriate advice for Richard because hearing aids can contribute to the accumulation of earwax. The repeated need for ear syringing suggests that Richard may be experiencing wax impaction due to his hearing aids. Advising him that wax impaction may be the result of hearing aid use would help him understand the reason for his frequent ear syringing and potentially take steps to prevent it.

Emma should have her urine tested because nocturnal enuresis that persists beyond the age of 6 years may be a sign of an underlying medical condition. Testing the urine can help identify any potential issues such as a urinary tract infection or diabetes. It is important to rule out any underlying causes before considering other treatment options.

The correct answer is a) Loss of red reflex, reduced visual acuity in the affected eye, blood in the posterior chamber of the affected eye. These findings are consistent with a vitreous hemorrhage, which is a common complication of poorly controlled diabetes. Loss of red reflex indicates opacity in the vitreous humor, reduced visual acuity is a result of the hemorrhage obstructing light, and blood in the posterior chamber confirms the presence of bleeding.

Constipation in children may be a sign of systemic disease. This means that the child's constipation could be a symptom of an underlying medical condition that affects the entire body. The fact that the child has been suffering from constipation and soiling for many months, along with the finding of a loaded colon on examination, suggests that there may be an underlying issue causing the constipation. It is important for the child to be evaluated by a healthcare professional to determine the cause of the constipation and to ensure appropriate management and treatment.

Based on the given information, Joel presents with symptoms of dysuria and discharge from his penis. The results of the urethral swab and MSU show a few pus cells but no growth on either specimen. This suggests an infection in the urethra, but the specific cause cannot be identified. This is consistent with non-specific urethritis, which is an inflammation of the urethra that is not caused by a specific pathogen. Therefore, the most likely diagnosis in this case is non-specific urethritis.

Intramuscular phenytoin is not an appropriate action in this situation. Status epilepticus is a medical emergency characterized by prolonged or repeated seizures, and immediate treatment is necessary to prevent further complications or damage. The correct actions in this situation would include ABC resuscitation (ensuring airway, breathing, and circulation), checking blood glucose to rule out hypoglycemia as a possible cause of the seizure, administering high flow oxygen to maintain oxygen saturation, and using intranasal midazolam as a first-line treatment for acute seizure cessation. Intramuscular phenytoin is not recommended for the immediate management of status epilepticus due to its slow onset of action.

The correct answer is b) It is unlikely to be an STI in view of her normal screen 3 months ago. This advice would not be appropriate because the absence of an STI on a previous screen does not rule out the possibility of acquiring an STI at a later time. It is important to consider that STIs can be acquired through sexual contact with an infected partner, and the absence of symptoms or positive results on a previous screen does not guarantee that the current symptoms are not due to an STI. Therefore, it is important to consider STIs as a potential cause and provide appropriate advice and treatment.

Failure to thrive refers to inadequate growth or weight gain in children. While it is commonly associated with organic causes such as medical conditions or nutritional deficiencies, it can also be caused by psychosocial factors such as neglect or emotional deprivation. Therefore, statement a) is not true as failure to thrive does not always have an organic basis.

The patient's symptoms of a chronic rash on the face, recurrent conjunctivitis, and itchy eyes, along with the presence of papules and pustules on the cheeks and forehead, are consistent with the diagnosis of rosacea. Rosacea is a chronic skin condition that primarily affects the face, causing redness, flushing, and the development of papules and pustules. The patient's use of heavy makeup to cover the rash suggests that she may be self-conscious about her appearance, which is a common concern for individuals with rosacea.

The patient's presentation of a target-like rash with central pallor is consistent with erythema multiforme, which can be caused by various factors such as medications (aspirin), vitamin deficiencies, infections (Mycoplasma), and autoimmune conditions (ulcerative colitis). However, herpes zoster, also known as shingles, typically presents as a painful, blistering rash that follows a dermatomal distribution, rather than a target-like rash. Therefore, herpes zoster is not a likely cause of the patient's rash.

Martha's presentation of "bubbles of air" in her urine suggests the presence of a vesicocolic fistula. A vesicocolic fistula is an abnormal connection between the bladder and the colon, allowing air and feces to pass from the colon into the bladder. This can result in symptoms such as pneumaturia (air in the urine) and fecaluria (feces in the urine). Given Martha's age and medical history, including diverticular disease, a vesicocolic fistula is the most likely diagnosis.

In a patient with a left pleural effusion, there is accumulation of fluid in the pleural space, leading to compression of the underlying lung tissue. This results in reduced air entry at the affected area, which in this case is the left base. Dullness to percussion is also expected over the left base due to the fluid-filled space. Bronchial breathing, which is the abnormal transmission of bronchial sounds to the periphery, is heard above the area of the effusion due to consolidation of lung tissue. Therefore, option a) is the correct answer as it includes all these findings.

The most likely diagnosis for a 7-year-old girl who has developed nocturnal enuresis and urinary incontinence in the last week is a urinary tract infection (UTI). UTIs can cause symptoms such as increased frequency of urination, urgency, and incontinence. In children, UTIs are more common in girls and can be caused by bacteria entering the urinary tract. This is a likely diagnosis given the symptoms presented and the age of the patient.

The patient's symptoms of cold fingers and toes that turn white, then purple, and then return to normal are indicative of Raynaud's phenomenon. Raynaud's phenomenon is often associated with underlying connective tissue diseases such as rheumatoid arthritis or systemic lupus erythematosus, but it can also be associated with oesophageal disease. Therefore, option d) "It may be associated with oesophageal disease" is the correct answer.

A partial tear in the Achilles tendon is likely the cause of the senior partner's injury based on the symptoms described. A partial tear often does not show any signs on examination other than tenderness and swelling in the mid tendon. This means that there may not be any visible deformity or obvious signs of a tear, making it difficult to diagnose without further investigation. Therefore, option b) is the correct statement about his injury.

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The most likely diagnosis in this case is intermittent claudication. Intermittent claudication is a symptom of peripheral arterial disease (PAD) caused by atherosclerosis. The calf pain that worsens on walking is characteristic of intermittent claudication, as it is caused by inadequate blood flow to the muscles during exercise. The erythematous leg when sitting and blanching on elevation suggests poor blood circulation. Given the patient's history of poorly controlled type 2 diabetes, which is a risk factor for PAD, intermittent claudication is the most likely diagnosis.

The most likely diagnosis for Aziz's symptoms is superficial thrombophlebitis. Superficial thrombophlebitis is characterized by inflammation and blood clot formation in a superficial vein, typically in the legs. Aziz's acute onset of erythema, tenderness, and swelling on the side of his calf are consistent with this condition. Other options such as cellulitis, deep vein thrombosis, and gout may present with similar symptoms, but given Aziz's history of varicose veins, superficial thrombophlebitis is the most likely cause.

Unilateral pleural effusions may be an early sign of heart failure, as fluid can accumulate in the pleural space due to increased pressure in the pulmonary circulation. Pleural effusions can also result from ascites, as fluid can migrate from the abdominal cavity to the pleural space. Liver disease can cause pleural effusions due to impaired liver function and increased pressure in the hepatic circulation. Infection can also lead to pleural effusions, as the body's immune response can cause fluid to accumulate in the pleural space. However, pleural effusions do not need to be > 10ml to be visible on CXR.

Based on the given information, Casey has a thickening in the palm of her hand. The picture shows the appearance of her hand. The correct answer, option c), states that the 4th finger is commonly affected. This suggests that Casey may be experiencing Dupuytren's contracture, a condition where the connective tissue in the hand thickens and forms nodules, causing the fingers to bend towards the palm. This condition commonly affects the 4th and 5th fingers. Therefore, advising Casey about the common involvement of the 4th finger would be appropriate in this case.

The patient's presentation of a lump in front of her neck raises concern for a possible thyroid abnormality. The fact that the lump moves on swallowing suggests that it is likely a thyroid nodule. Given her age and the duration of the lump, it is important to refer her for specialist review. This is because thyroid nodules in older individuals have a higher risk of being malignant, and further evaluation is necessary to determine the nature of the lump and the need for further treatment.

The picture shows a small, reddish, fleshy growth at the urethral opening. This is consistent with a urethral caruncle, which is a benign lesion commonly seen in postmenopausal women. It can cause symptoms such as urinary frequency, dysuria, and hematuria. Given Betty's age, history of urinary tract infections, and the appearance of the lesion, urethral caruncle is the most likely diagnosis.

Glaucoma is a common eye condition that affects approximately 2% of the population. This statement provides information about the prevalence of glaucoma in the general population.

The most important diagnosis to consider in this case is neurological incontinence. This is because the patient, Jessica, has previously been continent but has recently developed nocturnal enuresis and urinary incontinence. This sudden onset of symptoms suggests a neurological cause, such as a spinal cord injury or nerve damage, which can disrupt the normal control of the bladder. Other potential causes, such as urinary tract infection or stress incontinence, may also be considered but are less likely given the presentation of new-onset incontinence in a previously continent individual.