A 26 year old woman has severe abdominal pain and heavy vaginal bleeding and is seen on the labour ward. Which is the most likely diagnosis?

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Placental abruption. Placental abruption is the premature separation of the placenta from the uterine wall before delivery, leading to abdominal pain and vaginal bleeding. This condition is a medical emergency that can result in significant maternal and fetal complications if not promptly addressed. Option A) Cervical ectropion is a benign condition involving the presence of glandular cells on the surface of the cervix and is not typically associated with severe abdominal pain and heavy vaginal bleeding. Option B) Disseminated intravascular coagulation (DIC) is a serious condition characterized by widespread activation of coagulation leading to bleeding and clotting. While DIC can cause bleeding, it is not specific to the scenario described. Option C) Placenta praevia is a condition where the placenta partially or completely covers the cervix, leading to painless bleeding in the third trimester, which is different from the clinical presentation provided in the question. Educationally, understanding the differential diagnosis of obstetric emergencies is crucial for healthcare providers working in labor and delivery settings. Recognizing the signs and symptoms of placental abruption is essential for timely intervention to prevent adverse outcomes for both the mother and the baby. This question highlights the importance of clinical acumen and prompt decision-making in identifying and managing psychiatric emergencies during pregnancy.

Correct Answer: D

Rationale: In this scenario, the most appropriate initial intravenous management for the 28-year-old pregnant woman with a generalised seizure and elevated blood pressure is option D) Magnesium sulfate. Magnesium sulfate is the drug of choice for managing eclampsia, which is characterized by seizures in pregnant women with hypertension. Magnesium sulfate acts as a central nervous system depressant and anticonvulsant, helping to prevent further seizures. It also has vasodilatory effects, which can help lower blood pressure. Option A) Diazepam is a benzodiazepine used for seizure control but is not the first-line treatment for eclampsia. Option B) Hydralazine is an antihypertensive medication that can be used for blood pressure management in pregnancy but is not the appropriate initial treatment for eclampsia. Option C) Levetiracetam is an antiepileptic drug that is not the first choice for managing eclamptic seizures in pregnancy. Educationally, understanding the appropriate management of psychiatric emergencies in pregnant women is crucial for healthcare providers working in obstetric settings. Knowing the specific medications and treatments for conditions like eclampsia can help prevent complications and improve outcomes for both the mother and the baby. It is essential to prioritize the safety and well-being of both patients in such high-risk situations.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Myelodysplasia. Myelodysplasia is a condition characterized by abnormal development and function of blood cells in the bone marrow, leading to low blood cell counts. In this case, the low hemoglobin level (64 g/L) and high mean corpuscular volume (MCV) of 103 fL indicate a macrocytic anemia, which is commonly seen in myelodysplasia. Option A) Folate deficiency typically presents with macrocytic anemia, but it is usually associated with a normal MCV. Option B) Haemolysis would present with a lower hemoglobin level and other blood cell abnormalities. Option C) Iron deficiency is associated with microcytic anemia, not macrocytic as seen in this case. In an educational context, understanding the specific laboratory findings associated with various hematological disorders is crucial in diagnosing and managing patients with hematologic conditions. This question challenges learners to apply their knowledge of hematology to a clinical scenario, reinforcing the importance of interpreting lab results in the context of a patient's presentation and medical history.

Correct Answer: A

Rationale: The most appropriate treatment for an 80-year-old woman with a painful right wrist and a distal radius fracture is option A) Below elbow backslab plaster of Paris. The rationale for this choice is based on the principles of managing distal radius fractures in elderly patients. Conservative management with a below elbow backslab plaster of Paris is preferred in this age group due to the potential risk of complications associated with surgical interventions, such as open reduction and internal fixation. Option B) Below elbow full plaster of Paris is not the best choice as it may restrict wrist movement unnecessarily, leading to stiffness and discomfort. Option C) Closed reduction of fracture may not provide adequate stability for proper healing in this elderly patient population. Option D) Open reduction and internal fixation is a more invasive approach that carries higher risks of complications in older adults. In an educational context, it is important for healthcare professionals to consider the age and specific needs of patients when determining the most appropriate treatment for distal radius fractures. Conservative management with a backslab plaster of Paris is often the preferred initial approach in elderly patients to minimize risks and promote optimal healing outcomes.

Correct Answer: A

Rationale: The correct answer is A) Long QT syndrome. Long QT syndrome is a cardiac condition characterized by a prolonged QT interval on ECG, which can lead to ventricular arrhythmias and fainting episodes. In this case, the patient's normal cardiac examination and presentation of recurrent fainting episodes without any structural heart abnormalities point towards an underlying electrical conduction issue like Long QT syndrome. Option B) Paroxysmal atrial fibrillation is less likely as it typically presents with symptoms of palpitations, irregular heart rhythm, and signs of an irregularly irregular pulse on examination. Option C) Sick sinus syndrome usually presents with symptoms of bradycardia, tachycardia, or pauses in the heart rhythm, which are not evident in this case. Option D) Trifascicular block would typically manifest with symptoms related to conduction abnormalities, such as syncopal episodes due to heart block, which are not described in the patient's presentation. Educationally, understanding the different causes of syncope is crucial for healthcare professionals, especially in psychiatric emergencies where patients may present with a wide range of symptoms. Recognizing the underlying etiology of syncope, such as Long QT syndrome in this case, is essential for appropriate management and treatment to prevent potentially life-threatening arrhythmias and complications. This question highlights the importance of considering both cardiac and non-cardiac causes of syncope in clinical practice.