A 22 year old woman requires long-term contraception and is reluctant to take regular tablets. Investigations: Transvaginal ultrasound: Enlarged uterus with multiple fibroids. Which is the most appropriate contraception?

Correct Answer: C

Rationale: The most appropriate contraception for a 22-year-old woman with an enlarged uterus and multiple fibroids who requires long-term contraception and is reluctant to take regular tablets is the Etonogestrel implant (Implanon), which is the correct answer (C). The rationale behind this choice is that the Etonogestrel implant is a highly effective, long-acting form of contraception that does not require daily administration, making it suitable for individuals who are averse to taking regular tablets. It is a small, flexible rod that is inserted under the skin of the upper arm and releases a steady dose of progestin hormone, providing contraception for up to three years. The other options provided are not as suitable in this scenario. The combined oral contraceptive pill (A) involves daily administration and may not be the best choice for someone who is reluctant to take regular tablets. The diaphragm (B) is a barrier method that requires insertion before intercourse and may not provide adequate long-term contraception. The Levonorgestrel-releasing intrauterine system (Mirena coil) (D) is an intrauterine device that is inserted into the uterus and can be highly effective for long-term contraception, but in the presence of multiple fibroids and an enlarged uterus, there may be concerns about proper placement and effectiveness. In an educational context, understanding the importance of selecting the most appropriate contraception for individual patients based on their preferences, medical history, and specific needs is crucial in providing quality healthcare. It is essential for healthcare providers to be knowledgeable about the various contraceptive options available and their indications, contraindications, and efficacy to guide patients in making informed decisions about their reproductive health.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Inability to hold eye contact. This behavior is concerning because eye contact is a fundamental component of social interaction and communication development in infants. At 18 months old, children typically begin to engage in reciprocal social interactions, including making eye contact with caregivers and others. Option A) Absence of hand dominance is not as concerning at this age as hand dominance typically emerges later in childhood and is not a significant developmental milestone for an 18-month-old. Option C) Inability to run or kick a ball is also not as critical at this stage as gross motor skills like running and kicking typically develop later in toddlerhood. Option D) Meaningless scribbling is expected in young children and is a normal part of early writing development, so it is not as worrisome in this context. Educationally, this question highlights the importance of understanding typical developmental milestones in infants and young children. It underscores the significance of early social communication skills, such as eye contact, in assessing a child's developmental progress. By recognizing deviations from expected behaviors, caregivers and healthcare providers can intervene early to support a child's healthy development.

Correct Answer: D

Rationale: In a psychiatric emergency exam scenario involving a 55-year-old woman with melaena, the most appropriate management of her diabetes prior to endoscopy would be to omit gliclazide on the morning of the procedure (Option D). The rationale for this choice is that gliclazide is a sulfonylurea, which can potentially cause hypoglycemia. During the endoscopy procedure, the patient may be fasting, which increases the risk of hypoglycemia if gliclazide is taken. Omitting gliclazide on the morning of the procedure helps to minimize this risk. Regarding the other options: - Option A: Changing gliclazide to metformin is not the best choice in this scenario as metformin does not directly address the risk of hypoglycemia associated with gliclazide. - Option B: Changing gliclazide to subcutaneous insulin may be too drastic a change without proper monitoring and adjustment of insulin dosage. - Option C: Omitting gliclazide for 24 hours prior to the procedure may lead to fluctuations in blood sugar levels and is not as precise as omitting it on the morning of the procedure. In an educational context, understanding the pharmacological properties of different diabetes medications and their effects on blood sugar levels in relation to fasting periods during medical procedures is crucial for healthcare providers managing patients with diabetes in various clinical scenarios. It is essential to tailor diabetes management strategies to individual patient needs to ensure optimal outcomes and prevent complications like hypoglycemia during procedures.

Correct Answer: D

Rationale: In the context of a psychiatric emergency exam, the most appropriate initial topical treatment for a 70-year-old woman with a red and scaly rash on her trunk seen by district nurses is Malathion (Option D). Malathion is commonly used to treat scabies, a parasitic infestation that can cause a red and scaly rash on the skin. It is effective in killing the scabies mites and their eggs, providing relief from the associated symptoms. Option A, Clobetasone, is a potent corticosteroid used to treat inflammatory skin conditions like eczema or psoriasis. While it can help with itching and inflammation, it is not the first-line treatment for a suspected scabies infestation. Option B, Clotrimazole, is an antifungal medication typically used to treat fungal skin infections like athlete's foot or yeast infections. It is not effective against scabies mites. Option C, Hydrocortisone, is a mild corticosteroid that can help with itching and mild inflammation in various skin conditions. However, it is not the appropriate treatment for scabies. In an educational context, understanding the appropriate use of different topical treatments for skin conditions is crucial for healthcare professionals, especially in emergency situations. Recognizing the specific presentation of scabies and knowing the appropriate treatment can help provide timely and effective care to patients, preventing further complications and improving their quality of life.

Correct Answer: A

Rationale: The correct answer is A) Cataract. In this case, the gradual deterioration of vision over 2 years in an 82-year-old woman is most likely due to cataracts. Cataracts are a common age-related condition where the lens of the eye becomes cloudy, leading to blurred vision. This matches the presentation described in the question. Option B) Diabetic retinopathy is less likely in this scenario as the patient's history does not mention diabetes, which is a significant risk factor for this condition. Diabetic retinopathy results from damage to blood vessels in the retina due to diabetes. Option C) Giant cell arteritis typically presents with symptoms such as headache, jaw pain, and vision changes, but the gradual deterioration of vision over 2 years is not typical for this condition. Option D) Glaucoma usually presents with gradual peripheral vision loss and increased intraocular pressure. While it can also cause vision changes, the gradual deterioration of vision in this case is more indicative of cataracts. Educationally, understanding the differential diagnosis of common eye conditions is crucial for healthcare providers to make accurate assessments and provide appropriate interventions. Recognizing the unique clinical presentations of each condition helps in timely management and referral, ultimately improving patient outcomes.