care of patient with minor illness MCQ

1.      Principles that guide the documentation of the consultation process in patient records include all of the following EXCEPT:

A) Be written clearly in permanent blue ink

B) Be signed, dated and timed

C) Be written sequentially or consecutively

D) Be factual and not include offensive or subjective statements

2.     The British Thoracic Society’s definition of a mild exacerbation of asthma is:

A) Adults and children >5years with peak flow >75% of anticipated maximum

B) Adults and children >5years with peak flow >60% of anticipated maximum

C) Adults and children >2 years with peak flow >75% of anticipated maximum

D) Adults and children without an audible wheeze

3.     The area where the thorax borders the abdomen is called:

A) The costal margin

B) The upper quadrant

C) The lower quadrant

4.     Which of the following IS NOT a sign or symptom of respiratory distress:

A) An expiratory grunt in children

B) Adoption of a supine position by the patient

C) Breathing through pursed lips

D) Nail bed cyanosis

5.     Which of the following findings would you NOT EXPECT in a patient with a chest infection:

A) Right lower lobe consolidation

B) Widespread crackles

C) Normal percussion findings

6.     Children are more prone to respiratory distress as a result of airway inflammation or infection because

A) They become more anxious than adults thus increasing the demand for oxygen

B) They do not have the ability to become tachypnoeic in response to respiratory insufficiency

C) They have funnel shaped airways with a narrow portion that is prone to occlusion and narrowing in disease

D) They contract diseases which are more likely to cause respiratory distress

7.     Patients with costochondritis will have pain on palpation of:

A) the junction of the ribs with the sternum

B) the junction of the ribs with the spine

C) the clavicle

D) the costal margin

8.     Which of the following signs and symptoms would lead you to suspect that a patient had otitis media:

A) Bulging, bright red or retracted tympanic membrane and fever

B) Inflammation of the external ear and crust formation on the auditory canal

C) Blocked feeling in the ear and reported reverberation of patients own voice

D) Sensor neural hearing loss and complaints of tinnitus

9.      Bacterial conjunctivitis is highly infectious and associated with the characteristic symptoms of:

A) Muco-purulent discharge and sticky eye after sleep or in the morning

B) Muco-purulent discharge and reduced visual acuity

C) Sub-conjunctival haemorrhage and reduced visual acuity

D) Severe photophobia and sticky eye after sleep or in the morning

10. Children are more prone to middle ear infections because:

A) Their Eustachian tube lies at a more acute angle to the middle ear than adults

B) Their Eustachian tube lies at a less acute angle to the middle ear than adults

C) They have less well developed tympanic membranes

D) They have less well developed Malleus, Incus and Stapes bones  

11.  In a 26 year old patient with a temperature of 39.2̊, and pain on swallowing you discover, when examining his throat, that he has deviation of the uvula. What is the most likely diagnosis:

A) Gingivitis

B) Peri-tonsillar abscess

C) Globus hystericus

D) Oral carcinoma

12. All of the following are sight threatening illnesses EXCEPT:

A) Acute glaucoma

B) Scleritis

C) Retinal detachment

D) Iritis

13. Which of the following is more suggestive of croup than epiglottitis:

A) Sudden onset of symptoms

B) Gradual onset of symptoms

C) Drooling

D) High temperature

14. A patient you are caring for has renal colic. All of the following would prompt you to refer the patient for admission EXCEPT:

A) Their pain had resolved in 45 minutes after NSAID analgesia

B) They have a temperature of 38.7°

C) They have only one functioning kidney

D) They have anuria

15. You will need to exclude all of the following before diagnosing renal colic EXCEPT:

A) Urinary Tract Infection

B) Pyelonephritis

C) Gastroenteritis

D) Aortic aneurysm

16. John, a 42 year old man, presents with a painful 1^st metatarsal. What findings would be suggestive of gout:

A) Bruising

B) Increased capillary refill time in the associated nail bed

C) Red inflamed joint

D) Reduced sensation

17. Herpes zoster infection is characterised by pain that may precede a skin rash by up to 5 days and a previous history of varicella (chicken pox) infection. Which of the following is also specifically diagnostic of herpes zoster infection:

A) Linear distribution of vesicles

B) Dermatomal distribution of vesicles

C) Hyperpyrexia

D) Pruritis

18. The following are all dermatological indicators of liver disease EXCEPT:

A) spider naevi

B) macular rash

C) palmar erythema

19. A patient presents with a painful elbow. What feature would indicate to you that the patient has olecranon bursitis:

A)    Full painless range of movement in the elbow

B)    Warm fluctuant swelling

C)    Crepitus

D)    Pain radiating to the shoulder

20. Carpal tunnel syndrome is caused by compression of which nerve:

A) Median nerve

B) Radial nerve

C) Ulnar nerve

D) Axillary nerve

21. Impetigo infection is characterised by:

A) Being highly contagious and having honey coloured peri-oral lesions

B) Being highly contagious and having petechial type lesions

C) Being highly contagious and having dermatomal distribution

22. Which form of skin cancer accounting for 1% of skin cancers but 60% of deaths caused by skin cancer is associated with this degree of mortality because it metastasises early

A) Basal cell carcinoma

B) Squamous cell carcinoma

C) Malignant melanoma  

23. Which of the following would give you cause for concern in a 2 year old child you are assessing?

A) Respiratory rate of 30

B) Pulse rate of 125

C) Blood pressure of 90/50

D) Cold limbs and a withdrawn mood

24. The four ‘geriatric giants’ is the name given to presentations that complicate assessment in the older patient. What are these four ‘geriatric giants’:

A) Confusion, incontinence, immobility and pressure sores

B) Confusion, immobility, incontinence and falls

C) Confusion, falls, shortness of breath and anxiety

25. Certain types of prescribed medication may contribute to the incidence of falls in the elderly: these may include all of the following EXCEPT:

A)    Diuretics

B)    Anti-hypertensives

C)    Hypnotic or sedative medication

D)    Non-steriodal anti-inflammatory drugs

26. Prescription and administration of emergency contraception is a feature of the work of many minor illness practitioners. Before you administer the medication to a 14 year old you will want to ensure, where possible, that all of the following conditions are true EXCEPT:

A)    That sex was consensual

B)    That the 14 year old has not been abused by an adult

C)    That parents are made aware of attendance even if she does not wish this

D)    That she obtains some sexual health education subsequent to the visit

27. Which one of the following IS NOT an indication for a chest x-ray:

A) Haemoptysis

B) Hypoxia

C) ?pneumothorax

D) Costochondritis

28. In abdominal obstruction what characteristic sign is found on the abdominal x-ray:

A) Air-fluid levels

B) Megacolon

C) Renal hypertrophy

D) Air under the diaphragm

29. In uncomplicated urinary tract infection in the adult female trimethoprim should be supplied for:

A) 7 days

B) 10 days

C) 3 days

30. Plantar fasciitis is typically seen in the overweight and those who undertake uncharacteristic levels of exercise. A diagnostic aid in plantar fasciitis is the fact that it is characterised by pain that is:

A) Worse in the evening

B) Worse on elevating the leg

C) Worse in the morning on first weight bearing

D) Worse on flexing the knee

Minor Illness MCQ Answers

1	A	Documentation should be in black ink to facilitate photocopying of records when necessary
2	A	The British Thoracic Society’s asthma guidelines refer to adults and children over 5 years old, where obtaining a peak flow recording is possible, and to children below 5 years of age where obtaining a peak flow recording is unlikely. In adults and children over 5 years of age the Society defines mild exacerbation of asthma as being associated with a peak flow recording of 75% or more of the expected maximum for the patient dependent upon age and gender
3	A	The costal margin is where the thorax borders the abdomen below the last rib - it is where a liver edge may be felt on the right side and sub-costal recession may be seen in patients, especially children, with increased respiratory effort
4	B	Adults breathe through pursed lips and children forcibly close the glottis producing an expiratory grunt in an effort to maintain positive end pressure during expiration. Nail bed cyanosis may be seen in hypoxic patients. Patients who are in respiratory distress will generally adopt an upright position bending slightly forwards (Fowler’s or tripod position) to maximise air intake during inspiration. They will not be comfortable lying supine.
5	A	Consolidation with fluid is associated with pneumonia and is not a feature of chest infection. Widespread crackles and normal findings on percussion of the chest are associated with chest infection
6	C	The trachea of a young child narrows like a funnel towards the larynx. The trachea of adults is a uniform lumen for its entire length. This narrow part of the trachea in the child occludes more readily during inflammatory and infective changes in the upper respiratory tract
7	A	Costochondritis is an inflammation of the ligaments of the sternal margins where the ribs attach to it. Its cause is largely unknown though it may occur after illness or injury. It is seen mainly in adolescents and young adults
8	A	Otitis media, an infection of the middle ear, will produce a red inflamed tympanic membrane which may bulge. The patient, usually a child, will have a fever. If the condition is chronic there may be a purulent discharge. A healthy tympanic membrane is flat and silver/grey in colour
9	A	Mild photophobia may be a feature of conjunctivitis but it should not be more severe than this. Reduced visual acuity is not expected in conjunctivitis
10	B	The Eustachian tube of a child lies at a less acute angle between the middle ear and the upper respiratory tract than is the case in the adult. This makes transmission of infection between the upper respiratory tract and the middle ear, and vice-versa, much easier
11	B	High fever, dysphagia and deviation of the uvula away from the abscess are some of the features of peritonsillar abscess or quinsy
12	B	Scleritis, or inflammation of the white of the eye, is not generally sight threatening whereas the raised intra-orbital pressures associated with glaucoma, the shearing of the retina away from the back of the eye in retinal detachment and the inflammation of the ciliary muscles and the iris in iritis are all potentially sight threatening processes
13	B	Croup is characterised by gradual onset and children or their parents may give a history of a viral like illness for a few days prior to development of other symptoms. Unless severe it is not generally associated with high fever and drooling or inability to swallow
14	A	Clinical Knowledge Summary guidelines for assessment and management of renal colic state that if pain can be controlled within an hour then discharge with appropriate aftercare may be considered. Anuria or having only one functioning kidney will prompt referral and associated fever may be indicative of systemic illness secondary to infective processes in the renal or urinary tract
15	C	Stagnation of urine behind large renal calculi may predispose to urinary tract infection and pyelonephritis. In older males especially with a sudden onset of severe pain in the back an aortic aneurysm will need to be excluded.
16	C	70% of patients with gout have the first episode in the 1st metatarsophalangeal joint of the big toe which becomes painful, red and inflamed
17	B	Herpes zoster infection always unilaterally follows the path of a dermatome. Thus it is seen on one side of the body or the other and when on the face a visible demarcation line may be seen along the midline of the face
18	B	Spider naevi and palmar erythema are indicative of liver disease. A macular rash is a flat rash where there is a change in colour of the skin, usually pink or red, and may be seen in measles or generalised allergic type rashes
19	B	Patients with olecranon bursitis may have movement limited by swelling and pain and should not have crepitus or radiation of pain to the shoulder joint
20	A	The median nerve passes through the carpal tunnel at quite a superficial level and is compressed during carpal tunnel syndrome. The median nerve provides sensory innervation to the thumb, index and middle fingers and in most people the lateral aspect of the ring finger also
21	A	Honey or brown coloured crusting lesions usually around the mouth and nose in children typify impetigo infection. It is highly contagious. Petechial lesions are caused by bleeding into skin from damaged blood vessels and dermatomal distribution of lesions is characteristic of herpes zoster infections
22	C	Basal cell carcinomas and squamous cell carcinomas do not in general metastasise as early as malignant melanomas
23	D	The haemodynamic observations are within normal limits for a 2 year old. Cold peripheries may indicate peripheral shutdown and vascular damage secondary to sepsis and withdrawn or altered mood may be attributable to raised intracranial pressure
24	B	These so called ‘Geriatric Giants’ may complicate assessment of the older patient and may be a cause or effect of illness in this patient group
25	D	Non-steroidal anti-inflammatory drugs are associated with an increased incidence of gastrointestinal bleeding in older patients but do not account for any higher incidence of falls
26	C	Providing the 14 year old is deemed Fraser competent then she is entitled to the same level of confidentiality as an adult attending for care. If she does not wish her parents to be informed then disclosure to them without adequate justification will constitute a breach of this confidentiality
27	D	There is no indication to x-ray a patient with inflammation of the ligaments at the sternal margins
28	A	Obstruction will lead to a backlog of entrapped air and fluid which will show up as fluid or air levels with a flat upper edge on the abdominal x-ray
29	C	3 days is now the recommended course of treatment in adult females and the 2007 NICE guidelines for the management of UTI in children now also advocate this in uncomplicated infections in children older than 3 years
30	C	Pain in plantar fasciitis is always worse when first weight bearing after sleep and this is particularly useful in diagnosing the condition