A 70 year old woman has lower abdominal pain for 5 days and is seen in her GP surgery. She feels unwell and has had episodes of shivering. There is a tender mass in the left iliac fossa. Which is the most likely diagnosis?

Correct Answer: A

Rationale: The correct answer is A) Diverticular abscess. In this case, the patient's presentation of lower abdominal pain, feeling unwell, shivering, and a tender mass in the left iliac fossa is indicative of diverticular abscess. Diverticular abscess occurs when an inflamed diverticulum becomes infected, leading to localized collection of pus. Option B) Incarcerated inguinal hernia is less likely as it typically presents with a bulge in the groin area, not a tender mass in the left iliac fossa. Option C) Sigmoid carcinoma is less likely in this scenario as it usually presents with other symptoms such as changes in bowel habits or rectal bleeding. Option D) Tubo-ovarian abscess is less likely as it is more common in younger women and is associated with pelvic inflammatory disease. In an educational context, understanding the differential diagnosis of abdominal pain is crucial for healthcare professionals, especially nurses working in emergency settings. By comprehensively analyzing patient symptoms and applying knowledge of common conditions, nurses can effectively triage and provide appropriate care to patients presenting with abdominal pain.

Correct Answer: D

Rationale: The most appropriate next investigation for a 24-year-old man with mild discomfort in his left scrotum for 4 months and palpable worm-like structures is option D) Semen analysis. Semen analysis is the most appropriate choice in this scenario because the symptoms described suggest a possible parasitic infection, such as a filarial worm infestation, which can be detected through semen analysis. This investigation can confirm the presence of any parasites in the reproductive system, providing valuable diagnostic information. Option A) Gram stained urethral smear is not the most appropriate choice in this case because the symptoms are related to scrotal discomfort, not urethral issues. Option B) Midstream urine for culture and sensitivity is also not the best choice as it is more relevant for urinary tract infections, which are not indicated by the symptoms presented. Option C) Scrotal exploration is an invasive procedure that should be reserved for cases where less invasive diagnostic methods have failed to provide a clear diagnosis. In an educational context, understanding the rationale behind choosing the most appropriate investigation based on the presented symptoms is crucial for nurses working in psychiatric emergency settings. This knowledge enables nurses to make informed decisions that lead to accurate diagnoses and appropriate treatment plans for patients presenting with unusual or concerning symptoms.

Correct Answer: A

Rationale: The correct answer is option A) Coeliac disease. In an 18-month-old girl presenting with poor weight gain and chronic loose stools, Coeliac disease is the most likely underlying cause. Coeliac disease is an autoimmune disorder triggered by gluten ingestion, leading to damage in the small intestine and impairing nutrient absorption, resulting in poor weight gain and gastrointestinal symptoms like loose stools. Option B) Cow's milk protein allergy is less likely in this case because although it can also present with gastrointestinal symptoms, it typically manifests more acutely after exposure to cow's milk proteins, unlike the chronic nature of symptoms described in the scenario. Option C) Crohn's disease is less common in infants and toddlers, and it usually presents with a different pattern of symptoms, such as abdominal pain, bloody stools, and more systemic symptoms beyond poor weight gain and loose stools. Option D) Lactose intolerance is also less likely in this case as it would typically present with symptoms like bloating, gas, and diarrhea shortly after consuming lactose-containing foods, rather than the chronic and persistent nature of symptoms described in the scenario. In an educational context, understanding the differential diagnosis of gastrointestinal symptoms in pediatric patients is crucial for healthcare providers, especially in identifying serious conditions like Coeliac disease early to initiate appropriate management and prevent long-term complications. This case highlights the importance of considering various causes of poor weight gain and chronic loose stools in pediatric patients to provide optimal care and improve outcomes.

Correct Answer: D

Rationale: In this scenario, the most likely diagnosis for a 31-year-old woman presenting with increasing shortness of breath and left-sided pleuritic chest pain for 1 week is a pulmonary embolism (PE). A PE occurs when a blood clot travels to the lungs, blocking one or more pulmonary arteries. The correct answer (D) is PE because the symptoms of shortness of breath and pleuritic chest pain are classic signs of a PE. Moreover, the risk factors for PE, such as recent surgery, prolonged immobility, or use of oral contraceptives, are common in young women. Option A, bronchiectasis, is less likely as it typically presents with chronic cough, sputum production, and recurrent respiratory infections. Option B, lung cancer, is less likely in a young non-smoking woman and would typically present with symptoms like persistent cough, weight loss, and hemoptysis. Option C, pneumonia, is less likely as it usually presents with fever, productive cough, and focal chest signs on examination. Educationally, understanding the presentation of PE is crucial in the field of psychiatric emergency nursing as patients with psychiatric conditions may have higher risks of developing conditions like PE due to factors such as sedentary lifestyle, obesity, or medication side effects. Nurses must be adept at recognizing atypical presentations of common conditions in psychiatric patients to ensure timely and appropriate interventions.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Phrenic nerve. The phrenic nerve innervates the diaphragm, the primary muscle responsible for breathing. Damage to the phrenic nerve can lead to difficulty breathing, as seen in the case of the man stabbed in the neck. Option A) Greater splanchnic nerve is not involved in respiratory function but rather plays a role in transmitting visceral sensory information. Option C) Recurrent laryngeal nerve is responsible for vocal cord movement and sensation in the larynx, not breathing. Option D) Spinal accessory nerve controls certain neck muscles, but not those directly involved in breathing. Understanding the anatomy and function of these nerves is crucial for nurses in a psychiatric emergency setting. In emergencies where respiratory distress is involved, identifying the nerve affected can help in providing appropriate care and interventions to support the patient's breathing. This knowledge enhances the nurse's ability to assess, intervene, and communicate effectively with the healthcare team in managing such critical situations.