A 54 year old man has swelling of both ankles and is seen in the GP surgery. He has hypertension and takes amlodipine. Which is the most likely cause of his ankle swelling?

Correct Answer: A

Rationale: The correct answer is A) Drug side effect. In this case, the patient's use of amlodipine, a calcium channel blocker, is the most likely cause of his ankle swelling. Amlodipine is known to cause peripheral edema as a common side effect due to its vasodilatory properties. This type of swelling is often bilateral and symmetrical, as seen in this patient. Option B) Heart failure is less likely in this case as the patient's ankle swelling is more likely to be due to a drug side effect rather than a cardiac issue. Heart failure-related edema tends to be more generalized and may be associated with other symptoms like shortness of breath, fatigue, and a history of heart disease. Option C) Lymphoedema is less likely as it is usually a chronic condition characterized by localized swelling due to lymphatic system dysfunction. It is less likely to present acutely in a patient like this with a recent onset of ankle swelling. Option D) Nephrotic syndrome is less likely as it typically presents with other symptoms such as proteinuria, hypoalbuminemia, and hyperlipidemia. Ankle swelling in nephrotic syndrome is usually a result of fluid retention due to kidney dysfunction rather than a drug side effect. In an educational context, understanding the common side effects of medications is crucial for healthcare providers to effectively assess and manage patients. Recognizing drug-induced adverse effects, like peripheral edema from amlodipine, can help prevent misdiagnosis and ensure appropriate treatment. This case highlights the importance of considering medication-related causes of symptoms in clinical practice.

Correct Answer: D

Rationale: In this scenario, the most likely diagnosis for a 74-year-old man presenting with a sudden severe headache and mild left-sided weakness in the Emergency Department is meningitis (Option D). Meningitis is an infection or inflammation of the meninges, the protective membranes covering the brain and spinal cord. The symptom of severe headache, along with focal neurological deficits like left-sided weakness, raises concern for meningitis as it can lead to neurological complications. Option A, benign intracranial hypertension, is less likely as it typically presents with symptoms like chronic headaches, vision changes, and papilledema, rather than sudden onset severe headaches and focal neurological deficits. Option B, brain tumor, may present with headaches and focal neurological deficits, but sudden onset severe headaches are more indicative of an acute condition like meningitis rather than a chronic condition like a brain tumor. Option C, encephalitis, is characterized by inflammation of the brain tissue and can present with neurological symptoms similar to meningitis. However, the sudden onset severe headache is more commonly associated with meningitis, making it a more likely diagnosis in this case. Educationally, understanding the distinguishing features of different neurological conditions is crucial for healthcare providers, especially in an emergency setting. Recognizing the specific symptoms and signs of conditions like meningitis, brain tumors, and encephalitis can aid in timely diagnosis and appropriate management, ultimately improving patient outcomes.

Correct Answer: A

Rationale: The most appropriate diagnostic investigation for a 23-year-old woman with worsening diarrhea that includes blood and mucus for 2 months is option A) Colonoscopy. Rationale: - Colonoscopy allows direct visualization of the entire colon and rectum, providing valuable information about the presence of inflammatory bowel disease, colorectal cancer, or other structural abnormalities that could be causing her symptoms. - Faecal calprotectin (Option B) is a marker of intestinal inflammation but is not specific enough to differentiate between various causes of bloody diarrhea. - Faecal occult blood (Option C) detects blood in the stool but does not provide information about the underlying cause of the bleeding. - Helicobacter pylori stool antigen test (Option D) is used to diagnose H. pylori infection, which is not directly related to the symptoms described. Educational context: Understanding the rationale behind selecting the most appropriate diagnostic test is crucial in clinical decision-making. In this case, choosing colonoscopy allows for a comprehensive evaluation of the colon and rectum, leading to a more accurate diagnosis and appropriate management of the patient's condition. It is essential for healthcare providers to be able to differentiate between various diagnostic tests to ensure optimal patient care and outcomes.

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: B

Rationale: The correct answer to the question is B) Haemorrhoids. Explanation: Haemorrhoids are a common cause of bright red, painless rectal bleeding in adults. They are swollen blood vessels in the rectum or anus that may cause bleeding during bowel movements. This condition is more likely in a 30-year-old woman presenting with painless rectal bleeding without any other associated symptoms. Why others are wrong: A) Anal fissure typically presents with painful rectal bleeding, in contrast to the painless bleeding described in the case scenario. C) Meckel diverticulum is a congenital anomaly that usually presents with symptoms in childhood and is less likely in an adult with recurrent rectal bleeding. D) Systemic bleeding disorder would present with bleeding from multiple sites in the body, rather than isolated rectal bleeding. Educational context: Understanding the different causes of rectal bleeding is crucial in the assessment of patients presenting with such symptoms, especially in the context of psychiatric emergencies where medical conditions can also manifest. This knowledge helps healthcare providers make accurate diagnoses and provide appropriate treatment. It is essential to distinguish between benign conditions like haemorrhoids and more serious conditions that may require urgent intervention.