A 75 year old man has attended the Emergency Department with bruising to his forearms and face. Which is the most likely explanation for his bruising?

Correct Answer: B

Rationale: In the context of psychiatric emergencies, it is crucial to consider the possibility of non-accidental injuries, especially in vulnerable populations like the elderly. The correct answer, B) Non-accidental injury, is the most likely explanation for the bruising in this case. Elder abuse, including physical abuse resulting in bruising, is unfortunately common and often underreported. Option A) Bleeding disorder is less likely in the absence of a history of bleeding tendencies or anticoagulant use. Occult malignancy, option C, typically presents with more generalized symptoms rather than localized bruising. Scurvy, option D, is rare in developed countries and is associated with a deficiency in Vitamin C, which would usually present with additional symptoms like poor wound healing and swollen gums. Educationally, understanding the signs and symptoms of elder abuse, including non-accidental injuries, is crucial for healthcare providers, especially those working in emergency departments or psychiatric settings. Recognizing and addressing such issues promptly can prevent further harm to the patient and ensure their safety and well-being.

Correct Answer: B

Rationale: In this scenario, the most appropriate topical treatment for a 38-year-old woman presenting with red sore eyes with crusting in the morning for 9 days is option B) Antibacterial. The rationale behind this choice is that the symptoms described suggest a possible bacterial infection such as bacterial conjunctivitis, commonly known as pink eye. Antibacterial eye drops or ointment would be the most effective treatment to address the underlying infection. Option A) Anaesthetic is not the best choice in this case because it would only provide symptomatic relief by numbing the eye and would not treat the underlying cause of the symptoms. Similarly, option C) Antiviral would not be appropriate unless there is a confirmed viral infection, which is not indicated based on the symptoms described. Option D) Mydriatic is used to dilate the pupil and would not be the correct choice for treating a bacterial eye infection. In an educational context, it is crucial for healthcare professionals to be able to differentiate between various eye conditions and select the most appropriate treatment based on the presenting symptoms. Understanding the indications for different types of eye medications is essential in providing effective care for patients with eye complaints. By choosing the correct treatment, healthcare providers can help alleviate symptoms, promote healing, and prevent potential complications.

Correct Answer: D

Rationale: The most appropriate long-term treatment for a 32-year-old woman experiencing intermittent palpitations, paraesthesia, breathlessness, and dizziness for 6 months is option D) Propranolol. Propranolol is a beta-blocker commonly used to treat symptoms of anxiety, such as palpitations and tremors, by reducing the effects of adrenaline on the body. In this case, the symptoms described suggest an underlying anxiety disorder, and propranolol can help alleviate physical symptoms associated with anxiety. Option A) Amitriptyline is a tricyclic antidepressant that may be used to treat anxiety disorders, but it is not the first-line treatment for symptoms like palpitations and dizziness. Option B) Diazepam is a benzodiazepine used for acute anxiety relief or panic attacks, not recommended for long-term use due to the risk of dependence and tolerance. Option C) Moclobemide is a reversible inhibitor of monoamine oxidase A (RIMA) used in the treatment of depression and social anxiety disorder, but it is not the first choice for the symptoms described. In an educational context, understanding the rationale behind selecting the appropriate medication for psychiatric emergencies is crucial for healthcare providers, especially in psychiatric settings or emergency departments. Recognizing the specific symptoms and matching them with the most suitable medication is essential for effective treatment and patient care. Propranolol's mechanism of action in managing physical symptoms of anxiety makes it a suitable choice in this scenario, highlighting the importance of tailored treatment approaches in psychiatric care.

Correct Answer: D

Rationale: In the context of assessing fertility, the correct day to measure serum progesterone levels is day 21 of the menstrual cycle. This is because day 21 typically corresponds to the peak of progesterone production from the corpus luteum following ovulation. By measuring progesterone levels on this day, healthcare providers can evaluate whether ovulation has occurred and assess the adequacy of luteal phase progesterone levels, which is crucial for successful implantation and pregnancy maintenance. Option A) Day 7 is too early in the menstrual cycle to accurately assess progesterone levels related to ovulation as it precedes the usual timing of ovulation. Option B) Day 14 is around the time of ovulation, but progesterone levels peak after ovulation has occurred, making day 21 a more appropriate time for assessment. Option C) Day 21 is the correct day for measuring serum progesterone levels in the menstrual cycle, as explained above. Option D) Day 25 is too late in the cycle for an accurate assessment of progesterone levels related to ovulation, as progesterone levels start to decline towards the end of the luteal phase. Understanding the timing of progesterone assessment in the menstrual cycle is crucial for healthcare providers when evaluating fertility issues and determining the appropriate management for patients trying to conceive. By selecting day 21 for progesterone measurement, healthcare providers can gather valuable information to guide further investigations and interventions to support conception and pregnancy.

Correct Answer: D

Rationale: The correct answer is D) Induced sputum microscopy. In a patient presenting with left-sided chest pain on inspiration, particularly in an acute medical setting, the most likely concern is a respiratory issue such as pneumonia. Induced sputum microscopy can help identify the presence of pathogens in the lower respiratory tract, aiding in the diagnosis of pneumonia. Option A) Blood cultures may be useful in cases of suspected sepsis or systemic infection, but in this scenario, where the primary symptom is chest pain on inspiration, it is not the most appropriate initial investigation. Option B) Bronchoscopy is an invasive procedure that is typically reserved for cases where there is a specific indication to visualize the airways or obtain samples directly from the lungs. It is not the first-line investigation for a patient with chest pain on inspiration. Option C) CT scan of the chest can provide detailed imaging of the chest structures but is not the initial investigation of choice when pneumonia is suspected. It may be considered if the diagnosis remains unclear after initial evaluations. In an educational context, understanding the rationale behind selecting the most appropriate investigation based on presenting symptoms is crucial for healthcare providers. It helps in developing clinical reasoning skills and ensures efficient and effective patient care by guiding the selection of diagnostic tests that are most likely to yield relevant information for the presenting clinical scenario.