A 65 year old man has worsening localised lumbar back pain and difficulty passing urine. He has multiple myeloma. Which is the most appropriate investigation?

Correct Answer: C

Rationale: In this scenario, the most appropriate investigation for the 65-year-old man with worsening localized lumbar back pain, difficulty passing urine, and a history of multiple myeloma is a MRI scan of the lumbar spine (Option C). The rationale behind choosing an MRI scan is that it is the most sensitive imaging modality for evaluating spinal cord compression, which could be a potential complication of multiple myeloma due to the presence of spinal tumors or pathological fractures. MRI can provide detailed information about the soft tissues, bone marrow, and neural structures in the lumbar spine, allowing for the detection of any compressive lesions or spinal cord abnormalities. Electromyogram (Option A) is not the most appropriate investigation in this case because it is used to evaluate muscle and nerve function, which would not provide information about potential spinal cord compression or structural lesions. A lumbar X-ray (Option B) may show bony changes associated with multiple myeloma such as lytic lesions, but it is less sensitive than an MRI for detecting soft tissue abnormalities or spinal cord compression. A myelogram (Option D) involves injecting a contrast dye into the spinal canal and then taking X-rays, which can be invasive and carries a higher risk compared to an MRI. It is usually reserved for cases where MRI is contraindicated or when MRI findings are inconclusive. In an educational context, understanding the appropriate diagnostic approach in patients with multiple myeloma and suspected spinal cord compression is crucial for healthcare professionals involved in the care of such patients. This case highlights the importance of selecting the most sensitive imaging modality to ensure timely diagnosis and appropriate management of spinal cord complications in patients with multiple myeloma.

Correct Answer: C

Rationale: In this scenario, the most likely diagnosis for the 12-year-old boy with painful blisters that burst, leaving shallow lesions, and who has eczema is option C) Eczema herpeticum. Eczema herpeticum is a rare but serious viral infection caused by the herpes simplex virus in individuals with pre-existing skin conditions like eczema. The correct answer is C because the presentation of painful blisters bursting in a child with eczema is indicative of a secondary herpes simplex virus infection, which can lead to Eczema herpeticum. Option A) Atopic eczema is a common form of eczema characterized by dry, itchy skin but does not typically present with painful blisters that burst. Option B) Chicken pox would present with vesicles in different stages of development, not necessarily painful blisters that burst leaving shallow lesions. Option D) Impetigo is a bacterial skin infection that presents with honey-colored crusts or fluid-filled blisters, not typically painful blisters that burst in a child with eczema. Understanding the differentiation between these conditions is crucial in the context of psychiatric emergencies to ensure appropriate and timely intervention for the child's skin condition, as well as addressing any psychological distress that may arise from the physical symptoms. Early recognition and management of Eczema herpeticum can prevent serious complications and improve the child's overall well-being.

Correct Answer: D

Rationale: The correct answer is D) Occurs in inner subjective space because pseudo-hallucinations are experienced as originating within the mind, in contrast to hallucinations which are perceived as external stimuli. This differentiation is crucial in understanding the subjective nature of the experience and guiding appropriate interventions in psychiatric emergencies. Option A) "As vivid as real" is incorrect because both hallucinations and pseudo-hallucinations can be vivid experiences, so vividness alone does not differentiate the two. Option B) "Sensory organs are not involved" is incorrect because both pseudo-hallucinations and hallucinations can occur without actual external sensory stimuli, so the involvement of sensory organs does not differentiate between them. Option C) "Involuntary" is incorrect because both pseudo-hallucinations and hallucinations can be involuntary experiences, so the presence of involuntariness does not distinguish between the two. In an educational context, understanding the distinction between pseudo-hallucinations and hallucinations is essential for healthcare providers, particularly in psychiatric settings where accurate assessment and diagnosis are crucial for appropriate treatment and care planning. It also highlights the complexity of perceptual disturbances in psychiatric emergencies and the need for a nuanced understanding of patients' experiences.

Correct Answer: C

Rationale: In the context of psychiatric emergencies, it is crucial for healthcare professionals to understand the prognostic factors associated with schizophrenia. In this scenario, the correct answer is option C) Insidious onset. Insidious onset in schizophrenia is actually a poor prognostic factor, contrary to the other options. An insidious onset refers to a gradual and subtle development of symptoms over time, often making early detection and intervention challenging. This delayed recognition and treatment can lead to a more severe course of the illness and poorer outcomes. Option A) Presence of mood symptoms can be a good prognostic factor as it may indicate a milder form of the illness or better response to treatment. Option B) Prominent positive symptoms, such as hallucinations or delusions, can also suggest a more treatable form of schizophrenia. Option D) Being married or having a strong social support system is generally considered a positive prognostic factor in schizophrenia as it can aid in recovery and treatment adherence. Understanding these prognostic factors is essential for healthcare providers working with individuals experiencing psychiatric emergencies. By recognizing these factors, clinicians can better tailor their interventions and treatment plans to improve outcomes for patients with schizophrenia. It underscores the importance of comprehensive assessment and individualized care in managing psychiatric emergencies effectively.

Correct Answer: B

Rationale: The correct answer is B) Postpartum blues. This condition typically occurs within the first few days after childbirth and is characterized by symptoms such as tearfulness, mood swings, and mild insomnia. Postpartum blues are considered a normal and transient condition affecting up to 80% of new mothers. Option A) Postpartum depression is a more severe and longer-lasting form of mood disorder that can occur within the first year after childbirth. It is characterized by persistent feelings of sadness, hopelessness, and worthlessness. Option C) Postpartum psychosis is a rare but serious condition characterized by hallucinations, delusions, and severe mood disturbances. It requires immediate medical attention as it poses a risk to both the mother and the infant. Option D) Postpartum anxiety is characterized by excessive worry, restlessness, and irritability. While anxiety can coexist with postpartum blues, it is not the primary diagnosis in this case. Educationally, it is crucial for healthcare providers to differentiate between these postpartum mood disorders as they have different implications for the mother's well-being and require different management strategies. Understanding the nuances of these conditions can help healthcare professionals provide appropriate support and interventions to mothers experiencing postpartum emotional challenges.