CLINICAL CPS MSRA MOCK PAPER 4 (timed)

A 45-year-old male presents to the emergency department with sudden onset of sharp chest pain that radiates to his left shoulder and is worse when lying down. He also reports mild fever and fatigue over the last few days. His past medical history is unremarkable. On examination, he has a temperature of 38.0°C, heart rate of 95 bpm, and blood pressure of 130/85 mmHg. Auscultation reveals a pericardial friction rub. ECG shows diffuse ST elevation and PR depression.

What is the most appropriate initial management for this patient?

A 55-year-old man diagnosed with acute coronary syndrome presents for a management plan. The healthcare provider discusses immediate and supportive care options with him.

What is the most appropriate initial management for a patient with acute coronary syndrome?

A 70-year-old woman is admitted to the coronary care unit with an acute anterior STEMI. She was given aspirin, clopidogrel, and underwent successful PCI. Post-procedure, she is hemodynamically stable with a heart rate of 78 bpm and blood pressure of 125/75 mmHg. However, she reports persistent fatigue and mild shortness of breath.

Which complication should be considered in this patient post-myocardial infarction?

A 68-year-old woman with a history of ST-elevation myocardial infarction presents for a follow-up visit. The healthcare provider discusses potential long-term complications associated with the condition.

Which of the following is a significant long-term complication associated with ST-elevation myocardial infarction?

During a cardiac arrest scenario, a 60-year-old male patient is in persistent ventricular fibrillation despite multiple shocks and administration of 1 mg adrenaline. After the third shock, he remains in ventricular fibrillation.

What is the next appropriate medication to administer?

A 65-year-old woman with a history of unstable angina presents for a follow-up visit. The healthcare provider discusses potential long-term complications associated with the condition.

Which of the following is a significant long-term complication associated with unstable angina?

A 16-year-old boy with a history of atopic dermatitis and allergic rhinitis presents to the GP with recurrent episodes of wheezing and shortness of breath. He reports that these episodes are often triggered by exposure to pollen and dust mites. He is currently using a short-acting beta-agonist inhaler as needed but finds it insufficient to control his symptoms.

Which additional medication is most appropriate for this patient’s asthma management?

A 65-year-old man with a history of asbestos exposure presents with progressive dyspnea and a dry cough. High-resolution CT scan shows honeycombing and pleural plaques.

What is the primary pathophysiological mechanism underlying asbestosis?

A 45-year-old male presents to the rheumatology clinic with a history of asthma and allergic rhinitis. He reports recent-onset fever, weight loss, and worsening peripheral neuropathy with mononeuritis multiplex. On examination, there are bilateral non-tender purpuric lesions on the lower extremities. Lung auscultation reveals wheezing, and there is sensory loss in a glove-and-stocking distribution.

Which of the following laboratory findings is most characteristic of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)?

A 30-year-old man presents with a history of wheezing, chest tightness, and cough that occurs primarily at night and after physical activity. His symptoms are relieved by using an over-the-counter inhaler. Physical examination is normal.

Which test is most useful in diagnosing asthma in this patient?

A 60-year-old male presents to the oncology clinic with progressive dyspnoea and chest pain over the past few months. He has a history of occupational asbestos exposure as a shipyard worker. On examination, there is dullness to percussion and decreased breath sounds over the left lung base. CT scan of the chest reveals pleural thickening and nodularity with pleural effusion.

Which of the following diagnostic tests is most appropriate for confirming the diagnosis of malignant mesothelioma in this patient?

A 6-year-old boy presents with a history of recurrent episodes of coughing, wheezing, and shortness of breath, particularly at night and early in the morning. His mother reports that these symptoms are often triggered by playing outside and exposure to cold air. He has no significant past medical history and no known allergies.

What is the most appropriate diagnostic test to confirm asthma in this child?

A 45-year-old man with a history of chronic alcohol use presents to the emergency department with abdominal pain, nausea, vomiting, and confusion. He reports that he has not eaten anything substantial for the past three days but has continued to consume large amounts of alcohol. On examination, he appears dehydrated and has a fruity odor to his breath. His observations are: heart rate 110 bpm, respiratory rate 24 breaths per minute, blood pressure 100/60 mmHg, and temperature 36.5°3. Blood tests reveal a high anion gap metabolic acidosis with the following results: glucose 5 mmol/L, bicarbonate 10 mmol/L, sodium 135 mmol/L, potassium 4.0 mmol/L, and chloride 98 mmol/12. Blood ketones are elevated.

What is the most likely diagnosis?

A 70-year-old woman with known achalasia presents with chest pain and regurgitation. She reports difficulty swallowing and has experienced significant weight loss.

Which of the following is a known complication of achalasia?

A 62-year-old man presents to the clinic with a 4-month history of intermittent abdominal pain, unintentional weight loss, and occasional episodes of blood in his stool. He also reports a change in bowel habits, alternating between constipation and diarrhea. On physical examination, there is a palpable mass in the right lower quadrant of the abdomen. Laboratory tests reveal a hemoglobin level of 10 g/dL and a positive fecal occult blood test.

What is the most appropriate initial investigation to confirm the diagnosis?

A 20-year-old man presents with right lower quadrant abdominal pain that began near the umbilicus and migrated. He also reports nausea, vomiting, and low-grade fever.

Which of the following clinical signs is most indicative of acute appendicitis?

A 35-year-old male with Crohn’s disease presents with a two-week history of increasing abdominal pain and bloating. He reports no bowel movements or flatus for the past 24 hours. On examination, his abdomen is distended and tender with high-pitched bowel sounds.

What is the most likely complication?

A 60-year-old man presents with acute mesenteric ischaemia due to a thrombotic occlusion of the superior mesenteric artery. The surgical team considers endovascular therapy.

Which of the following describes the role of endovascular therapy in the management of acute mesenteric ischaemia?

A 45-year-old woman presents to her GP with a 6-month history of fatigue, muscle weakness, and intermittent headaches. On examination, her blood pressure is 160/100 mmHg. Blood tests reveal a potassium level of 2.8 mmol/L (normal range: 3.5-5.0 mmol/L).

What is the most likely diagnosis?

A 30-year-old woman presents with symptoms of weight loss, palpitations, and heat intolerance. The clinician suspects Graves’ disease.

Which of the following best describes the pathophysiology of Graves’ disease?

A 25-year-old woman with Type 1 diabetes presents with DKA. Her initial blood glucose is 30 mmol/L, and her serum potassium is 4.5 mmol/12. She is started on intravenous fluids and insulin.

What is the most important initial step in the management of DKA?

A 65-year-old woman with type 1 diabetes has recurrent hypoglycaemia despite lifestyle modifications. The clinician considers pharmacological options to manage her condition.

Which of the following medications can be used to treat severe hypoglycaemia in emergency situations?

A 70-year-old man with a history of Type 2 diabetes mellitus presents to the emergency department with a 5-day history of increasing confusion, extreme thirst, and polyuria. He is lethargic and dehydrated. His blood glucose level is 40 mmol/L, and his serum osmolality is 320 mOsm/kg. There are no ketones in his urine.

What is the most likely diagnosis?

A 30-year-old man with untreated Kallmann’s syndrome presents with low bone density and fractures. The clinician considers potential complications associated with the disease.

Which of the following is a common complication associated with untreated Kallmann’s syndrome?

A 35-year-old man presents to the emergency department with confusion and lethargy. He has a history of alcohol use disorder and has been binge drinking for the past week. On examination, his blood pressure is 110/70 mmHg, heart rate is 100 bpm, and he appears dehydrated. Laboratory investigations reveal the following results: sodium 140 mmol/L, potassium 4.0 mmol/L, chloride 98 mmol/L, bicarbonate 10 mmol/L, blood urea nitrogen 8 mmol/L, creatinine 100 µmol/L, and glucose 5.5 mmol/12.

What is the most likely cause of his elevated anion gap metabolic acidosis?

A 65-year-old woman with multiple comorbidities is at risk for AKI. The clinician discusses preventive measures to reduce the risk of AKI.

Which of the following is an effective preventive measure to reduce the risk of acute kidney injury (AKI)?

A 32-year-old male presents with a two-week history of dark urine and swelling in his legs and face. He reports a recent sore throat a few weeks ago. On examination, his blood pressure is 150/95 mmHg, and there is periorbital and pedal oedema. Urinalysis reveals hematuria, proteinuria, and red blood cell casts. Blood tests show a serum creatinine of 180 µmol/L and an elevated anti-streptolysin O (ASO) titre.

What is the most likely diagnosis?

A 65-year-old man presents with progressive fatigue, polyuria, and anemia. He has a history of long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). The clinician suspects chronic interstitial nephritis.

Which of the following best describes chronic interstitial nephritis?

A 28-year-old male presents to the clinic with a painless lump in his right testicle that he noticed three weeks ago. He denies any trauma or infections. On examination, there is a firm, non-tender mass in the right testicle. Scrotal ultrasound reveals a hypoechoic mass. Serum tumor markers are obtained and show elevated beta-human chorionic gonadotropin (ß-hCG) but normal alpha-fetoprotein (AFP) levels.

What is the most likely diagnosis?

A 3-year-old boy diagnosed with Wilms’ tumour is undergoing treatment. The clinician discusses the key aspects of managing Wilms’ tumour.

Which of the following is a key aspect of managing Wilms’ tumour?

A 10-year-old male presents to the emergency department with a rapidly enlarging jaw mass over the past two weeks. He also reports night sweats and weight loss. Physical examination reveals a large, firm, non-tender mass in the right jaw. Laboratory tests show normal complete blood count and elevated lactate dehydrogenase (LDH). A biopsy of the mass is performed, revealing a “starry sky” appearance on histology.

What is the most likely diagnosis?

A 60-year-old woman is newly diagnosed with stage III DLBCL. She asks about the factors affecting her prognosis.

Which of the following is a positive prognostic factor for NHL?

A 10-year-old boy presents to the emergency department with a swollen and painful left ankle after a minor fall while playing. He has a history of prolonged bleeding after minor injuries and frequent bruising. There is no known family history of bleeding disorders. On examination, the left ankle is swollen, warm, and tender with limited range of motion. Laboratory tests show a normal platelet count, prolonged activated partial thromboplastin time (aPTT), and normal prothrombin time (PT). Factor IX activity is low.

What is the most likely diagnosis?

A 45-year-old man presents with fatigue and pallor. Laboratory tests show normocytic anaemia. The clinician suspects anaemia of chronic disease and decides to perform further diagnostic tests.

Which of the following is the most appropriate initial diagnostic test for suspected anaemia of chronic disease?

A 67-year-old man presents to his GP for a routine check-up. He has a history of hypertension, well controlled on medication. Blood tests reveal a serum protein electrophoresis showing a monoclonal protein (M-protein) spike of 1.2 g/dL. He has no symptoms of bone pain, renal impairment, or hypercalcaemia. Further tests show a normal haemoglobin level, normal renal function, and normal serum calcium.

What is the most appropriate next step in managing this patient’s condition?

A 60-year-old woman presents with severe menorrhagia and a platelet count of 20 x 10^9/12. She has a history of immune thrombocytopenia (ITP).

Which of the following is a significant risk factor for requiring platelet transfusion in this patient?

A 4-year-old boy is brought to the paediatric clinic by his parents due to concerns about his frequent falls and difficulty climbing stairs. They also mention he has a waddling gait and has difficulty rising from the floor. On examination, you notice hypertrophy of the calf muscles.

Which of the following investigations would most likely confirm the diagnosis of Duchenne muscular dystrophy?

A 70-year-old man presents with acute onset of lower limb weakness and loss of pain and temperature sensation following aortic surgery. His reflexes are absent, and he cannot move his legs. Proprioception and vibration sense are intact. The clinician suspects anterior spinal artery syndrome and orders imaging studies.

Which of the following diagnostic tools is most appropriate for confirming the diagnosis of anterior spinal artery syndrome?

A 40-year-old man presents with progressive muscle weakness over the past six months. He reports difficulty swallowing and occasional shortness of breath. On examination, he has ptosis, facial muscle weakness, and decreased strength in the proximal muscles of his limbs. Blood tests reveal the presence of anti-acetylcholine receptor antibodies.

Which of the following is the most appropriate initial treatment?

A 55-year-old man with a brain abscess in the right temporal lobe is admitted to the hospital. He presents with fever, headache, and speech difficulties. An MRI confirms the abscess, and blood cultures identify Streptococcus species. The patient is started on intravenous antibiotics, but his neurological status worsens.

Which of the following management strategies is most appropriate for this patient with a worsening brain abscess?

A 68-year-old man presents to the emergency department with sudden onset of right-sided weakness and difficulty speaking that began 1 hour ago. His medical history is significant for hypertension, diabetes mellitus, and atrial fibrillation. On examination, he has right-sided hemiparesis and expressive aphasia. His blood pressure is 180/95 mmHg, heart rate is 80 bpm, and he is in atrial fibrillation.

What is the most appropriate next step in the management of this patient?

A 17-year-old boy presents with worsening difficulty in walking, frequent falls, and slurred speech. On examination, he has significant ataxia, dysarthria, and loss of vibratory sense in the lower limbs. He also has pes cavus (high-arched feet) and scoliosis. The clinician suspects Friedreich’s ataxia.

Which of the following clinical features is most characteristic of Friedreich’s ataxia?

A 29-year-old woman presents with a history of vaginal discharge and lower abdominal pain. She is diagnosed with gonorrhoea following a positive nucleic acid amplification test (NAAT) from a cervical swab.

What is the first-line treatment for uncomplicated gonorrhoea according to UK guidelines?

A 30-year-old woman presents with dysuria, frequency, and urgency. She has no history of antibiotic resistance or complicated urinary tract infections.

Which of the following antibiotics is most appropriate for empirical treatment of an uncomplicated urinary tract infection?

A 30-year-old woman presents to the GP with a 10-day history of intermittent fever, chills, and headache. She recently returned from a trip to West Africa. On examination, she has a temperature of 38.5°C and mild hepatosplenomegaly. Blood tests reveal a normocytic, normochromic anemia.

What is the most likely causative organism?

A 1-month-old infant is being assessed in a clinic in the UK. The mother asks if her baby should receive the BCG vaccine.

Which of the following is the most appropriate indication for administering the BCG vaccine?

A 40-year-old woman presents with severe back pain, fever, and numbness in her lower extremities. MRI of the spine reveals a spinal epidural abscess at the thoracic level. She has a history of chronic kidney disease and is currently on hemodialysis.

What is the most appropriate initial management for this patient?

A 29-year-old pregnant woman is exposed to chickenpox but is unsure if she has had the infection or been vaccinated. She is concerned about the risks to her pregnancy.

Which of the following is the most appropriate indication for administering varicella-zoster immunoglobulin (VZIG)?

A 35-year-old woman presents with pain and swelling in her right calf after a long flight. She describes the pain as constant and throbbing. On examination, there is tenderness and increased warmth in the calf, and a positive Homan’s sign.

Which condition is most likely causing her symptoms?

A 30-year-old woman presents with severe pain and swelling in her forearm after a fall from a bicycle. She has a history of taking anticoagulants for a previous deep vein thrombosis. On examination, her forearm is swollen, tense, and extremely painful with passive finger extension.

Which of the following is the most likely risk factor for her condition?

A 30-year-old male soldier presents with persistent pain in his left foot, which started during an intensive training camp three weeks ago. He describes the pain as sharp and localized over the top of his foot, worsened by weight-bearing activities. On examination, there is pinpoint tenderness over the second metatarsal. Initial X-rays are normal.

Which imaging modality is most appropriate for confirming the diagnosis?

A 50-year-old woman with a history of mononeuritis multiplex presents with persistent weakness in her left leg and right hand, along with worsening sensory loss. Despite treatment, she has developed muscle atrophy in the affected areas and experiences significant functional impairment.

Which of the following is the most likely complication of her condition?

A 65-year-old woman presents with chronic back pain and recent onset of headaches. She has a history of Paget’s disease affecting her spine and skull. On examination, there is tenderness over the lumbar spine and mild hearing loss. Laboratory results show markedly elevated alkaline phosphatase levels. A bone scan reveals increased uptake in the lumbar spine and skull.

What is the primary treatment for this condition?

A 75-year-old woman with a history of lumbar spinal stenosis presents with worsening lower back pain and difficulty walking. She now experiences numbness and weakness in her legs and has difficulty controlling her bladder. Examination reveals decreased sensation in the lower extremities and reduced strength in the lower limbs.

Which of the following is the most likely complication of her condition?

A 2-year-old girl is brought to the emergency department with a fever of 38.5°C, ear pain, and decreased appetite. Her mother notes that she has been crying more than usual and tugging at her left ear. On otoscopic examination, the left tympanic membrane is erythematous, bulging, and has an opaque appearance.

What is the first-line treatment for this condition?

A 65-year-old man with a history of recurrent vertigo presents with a sudden, severe episode of vertigo accompanied by double vision, slurred speech, and weakness on one side of his body. He is unable to walk steadily and feels extremely dizzy.

Which of the following is the most likely complication of his condition?

A 55-year-old woman presents with dysphagia to solids and recent onset of odynophagia (painful swallowing). She also reports fatigue and a significant weight loss of 10 kg over the past two months. She has a history of heavy alcohol use and smoking. Physical examination reveals no significant findings.

Which diagnostic test is most appropriate to confirm the diagnosis of oesophageal cancer?

A 30-year-old woman presents with a severe sore throat, difficulty swallowing, and fever. Examination reveals swollen, erythematous tonsils with white exudates. A rapid antigen detection test for streptococcus is positive.

Which of the following is the most appropriate initial management for this patient?

A 30-year-old man presents with a severe sore throat, fever, and difficulty opening his mouth. He reports worsening throat pain over the past five days and difficulty swallowing. Physical examination reveals unilateral peritonsillar swelling, trismus, and uvular deviation. His temperature is 38.8°C, and he appears ill.

Which of the following is the most appropriate investigation to confirm the diagnosis?

A 50-year-old woman with a history of otosclerosis presents with worsening hearing loss despite using hearing aids. She also reports episodes of vertigo and imbalance. Examination reveals bilateral conductive hearing loss, and imaging shows abnormal bone growth around the stapes and inner ear structures.

Which of the following is the most likely complication of her condition?

A 65-year-old man visits the ophthalmologist complaining of blurred vision and difficulty reading small print for the past several months. He also notices halos around lights, especially at night. His medical history includes well-controlled hypertension and type 2 diabetes. On slit-lamp examination, there are bilateral lens opacities.

What is the most appropriate treatment for this condition?

A 45-year-old woman presents with sudden onset of blurred vision and a dark shadow in her right eye. She has a history of high myopia and recently noticed flashes of light and floaters. On examination, there is a marked reduction in visual acuity, and fundoscopy reveals a retinal tear with detachment.

Which investigation is most appropriate to confirm the diagnosis of retinal detachment?

A 28-year-old man presents with a red, mildly painful left eye that has persisted for three days. He denies discharge, photophobia, or visual disturbances. Examination reveals a localized, sectoral area of redness over the sclera with mild tenderness. His medical history is unremarkable, and he does not wear contact lenses.

What is the most appropriate initial treatment for this condition?

A 60-year-old man is diagnosed with primary open-angle glaucoma after a routine eye exam revealed elevated intraocular pressure, optic disc cupping, and visual field loss. His visual acuity is still good, and he has no symptoms. The ophthalmologist decides to start treatment to prevent further vision loss.

Which is the most appropriate initial management for this patient?

A 45-year-old man presents with a red, painful right eye and decreased vision. He reports a history of herpes simplex virus (HSV) infections and notes similar episodes in the past. Slit-lamp examination reveals a dendritic ulcer on the cornea.

What is the most appropriate initial treatment for this condition?

A 35-year-old woman presents with a history of recurrent herpes simplex keratitis. She is experiencing a flare-up with symptoms of eye pain, redness, and decreased vision in her right eye. On examination, there is a dendritic ulcer visible on fluorescein staining.

What is the most appropriate initial management for this condition?

A 9-year-old boy is brought to the clinic by his parents due to episodes of facial twitching and drooling that occur primarily at night. These episodes last for about 1-2 minutes and are followed by a period of confusion. His developmental history is normal, and there is no family history of epilepsy. The episodes have been occurring for the past six months. An electroencephalogram (EEG) is performed.

What is the most likely finding on the EEG?

A 5-year-old boy diagnosed with vesicoureteric reflux (VUR) presents for a management plan. The healthcare provider discusses immediate and supportive care options with the parents.

What is the most appropriate initial management for a child with mild vesicoureteric reflux?

A 6-year-old girl is brought to the clinic due to concerns about excessive weight gain, constant hunger, and behavioural issues. On physical examination, she has short stature, small hands and feet, and mild developmental delays. The parents report that she was diagnosed with hypotonia and poor feeding as an infant.

What genetic mechanism is responsible for Prader-Willi syndrome?

A 6-year-old boy with a history of acute epiglottitis presents for a follow-up visit. The parents are concerned about potential long-term complications associated with the condition.

Which of the following is a significant complication associated with acute epiglottitis?

A 2-year-old boy is brought to the emergency department by his parents due to a sudden onset of a barking cough, hoarseness, and difficulty breathing. The symptoms began last night and worsened significantly, especially at night. On examination, the child has inspiratory stridor and a fever of 38.5°3. His oxygen saturation is 95% on room air.

What is the most likely diagnosis?

A newborn is diagnosed with an umbilical hernia. The healthcare provider discusses potential risk factors with the parents to help them understand why their baby developed this condition.

Which of the following is a significant risk factor for developing an umbilical hernia in a newborn?

A 30-year-old woman presents to the antenatal clinic at 34 weeks of gestation with headaches and visual disturbances. Her blood pressure is 160/100 mmHg, and urinalysis shows 3+ proteinuria. She has no significant past medical history and her pregnancy has been uncomplicated until now. She reports no abdominal pain or vaginal bleeding.

What is the most appropriate next step in the management of this patient?

A 30-year-old woman, Rhesus negative, delivered a Rhesus positive baby in her previous pregnancy and did not receive adequate anti-D prophylaxis. She is now 20 weeks pregnant and worried about the potential complications.

Which of the following is a significant complication of Rhesus sensitisation in a subsequent pregnancy?

A 30-year-old woman with a known diagnosis of PCOS presents to the clinic with concerns about her fertility. She has been trying to conceive for the past year without success. Her menstrual cycles are irregular, and she has a history of hirsutism and obesity.

Which of the following is the most appropriate initial treatment to help her conceive?

A 35-year-old woman, four weeks postpartum, reports feeling constantly sad, exhausted, and unable to cope with the demands of her newborn. She has a history of depression and anxiety, and she lacks a supportive network.

Which of the following is a significant risk factor for developing postnatal depression in this patient?

A 28-year-old woman, G2P1, is in active labor at 39 weeks of gestation. After a prolonged second stage, she delivers the fetal head, but the shoulders fail to deliver with the next contraction. The obstetrician notes that the fetal head retracts slightly against the perineum, creating the “turtle sign.” The baby’s shoulders are stuck, and there is no further progress despite maternal pushing.

What is the most appropriate immediate management step for this patient?

A 45-year-old woman with known uterine fibroids presents with sudden onset of severe pelvic pain and fever. On examination, she has a tender, palpable mass in the lower abdomen.

What is the most likely complication of uterine fibroids in this patient?

A 60-year-old man with a history of alcohol dependence presents with confusion, unsteady gait, and nystagmus. His symptoms suggest Wernicke’s encephalopathy.

What is the most appropriate immediate treatment for this patient?

A 55-year-old man with a history of chronic alcohol dependence presents to the emergency department with confusion, unsteady gait, and eye movement abnormalities. His family reports that he has been unable to walk steadily for the past few days and has been increasingly confused.

Which of the following clinical features is most commonly associated with Wernicke’s encephalopathy?

A 28-year-old man reports experiencing recurrent panic attacks, accompanied by chest pain, dizziness, and a fear of dying. He avoids situations where he previously had panic attacks, fearing they might occur again.

Which of the following is NOT a diagnostic criterion for panic disorder according to DSM-5?

A 40-year-old woman with generalized anxiety disorder (GAD) presents for follow-up. She has been on sertraline 50 mg daily for the past eight weeks but reports only partial improvement in her anxiety symptoms. She continues to experience significant worry and physical tension, which impacts her daily functioning.

Which of the following is the most appropriate next step in the management of this patient?

A 40-year-old man with a history of schizophrenia is brought to the emergency department by his family. He has been experiencing severe psychotic symptoms, including hallucinations and delusions, and has stopped taking his medication. He is agitated, refusing to eat, and his family is concerned for his safety.

Under which section of the Mental Health Act 1983 (as amended by the Mental Health Act 2007) would this patient most likely be detained for assessment?

A 45-year-old male with a history of schizophrenia presents to the emergency department with severe agitation and paranoid delusions. He believes that his neighbors are planning to harm him and refuses to leave his house. His family is concerned about his safety and his inability to care for himself. He has refused voluntary admission to the hospital.

Which of the following is a criterion for sectioning under the Mental Health Act?

A preterm infant who was treated for Infant Respiratory Distress Syndrome presents for a follow-up visit. The parents are concerned about potential long-term complications associated with the condition.

Which of the following is a significant long-term complication associated with Infant Respiratory Distress Syndrome?

A 30-year-old male presents to his GP with sudden onset of round patches of hair loss on his scalp. The patches are smooth, non-scaly, and there is no associated itching or pain. He reports no significant medical history but mentions that his sister has a thyroid disorder.

What is the most likely diagnosis in this patient?

A 28-year-old woman presents to the GP with a painless lump on her upper back. She first noticed the lump several months ago, and it has gradually increased in size. On examination, there is a 2 cm, firm, mobile, subcutaneous nodule with a central punctum. The overlying skin appears normal.

What is the most likely diagnosis?

A 35-year-old woman presents with persistent itching and scaling between her toes. She reports that the symptoms have been present for several months and have not responded to over-the-counter antifungal creams. On examination, there is maceration and peeling of the skin between the fourth and fifth toes, with some areas of erythema.

What is the most appropriate initial diagnostic test for this condition?

A 35-year-old woman presents with chronic urticaria that has been ongoing for six months. She experiences itchy wheals almost daily, which often disrupt her sleep. She has tried over-the-counter antihistamines with partial relief. There is no known trigger, and she is otherwise healthy.

What is the next step in managing this patient’s chronic urticaria?

A 3-year-old boy with a history of atopic dermatitis presents with rapidly worsening eczema on his face and neck. The lesions are painful, with multiple punched-out erosions, vesicles, and some crusting. He has a fever and appears generally unwell.

What is the most likely diagnosis?

A 65-year-old man presents with widespread, erythematous plaques that have been slowly progressing over several years. He has been diagnosed with mycosis fungoides and has started experiencing pruritus and thickening of the plaques.

What is the most appropriate first-line treatment for early-stage disease?

A 45-year-old woman presents with intensely itchy, violaceous, polygonal papules on her wrists and ankles. The lesions have a fine white lace-like pattern (Wickham’s striae) on the surface. She also mentions soreness in her mouth.

What is the most likely diagnosis?

A 55-year-old woman with a history of estrogen-receptor positive breast cancer is currently being treated with anastrozole. She reports worsening back pain, and imaging reveals reduced bone density.

What is the most appropriate management strategy to address her osteoporosis risk?

A 50-year-old woman taking simvastatin 40 mg daily for dyslipidemia is started on amiodarone for atrial fibrillation. After a few weeks, she complains of muscle pain and fatigue. Laboratory tests confirm elevated creatine kinase levels.

What is the best management strategy to avoid these adverse effects?