Plymouth Med
Quiz by , created more than 1 year ago

Content credits to Elliot Catchpole and her references: http://www.gpnotebook.co.uk/simplepage.cf m?ID=-1630535645&linkID=19149&cook=yes • http://patient.info/doctor/immunisation- schedule-uk • http://patient.info/doctor/human-and- animal-bites

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Plymouth Med
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AMK tricky scenarios :)

Question 1 of 4

1

Mrs Jones comes in with her 1-year-old baby son for his 1st MMR immunisation. Her son is alert and has a cold-like illness and is exhibiting coryzal symptoms. Mrs Jones also informs you that one of her other children, her 6 year old daughter, is currently receiving high dose chemotherapy for recently diagnosed leukaemia.
What is the most appropriate course of action?

Select one of the following:

  • Proceed to immunize the child

  • Postpone until the sibling has completed their cancer treatment

  • Postpone until the child has recovered from his acute illness

  • Use an ‘inactivated’ form of MMR vaccine

  • Consult the community paediatrician for advice

Explanation

Question 2 of 4

1

Mrs Pike has brought her 1-year-old son for his second dose of MMR. She is concerned as she said he had a ‘reaction’ to the previous dose. He developed coryzal symptoms and a cough 6 days after the vaccine was administered. She thinks this was due to his egg allergy. Mrs Pike is also 18 weeks pregnant.
On examination the child appears well and afebrile. He has Down’s syndrome and is currently taking high-dose topical steroids and flucloxacillin for an infective exacerbation of moderate eczema 4 days previously. He is also due to have a 2nd operation with general anaesthesia on his foot tomorrow afternoon. What is the most appropriate course of action?

Select one of the following:

  • Reassure the mother and vaccinate the child

  • Postpone until he has had his reaction and allergy followed up by an immunologist

  • Postpone until he has recovered from his operation and general anaesthetic

  • Postpone until his skin infection has cleared

  • Postpone until she has delivered her new baby

Explanation

Question 3 of 4

1

A young girl presents to A&E with her father after being bitten by a feral dog on her left hand. The skin is broken although the wound does not appear to run very deep. The incident happened around 2 hours ago when they were out in Dartmoor together. She is alert and well, although still in some pain. All examinations are normal, including musculoskeletal exam of her left upper limb. She is on no medications and reports no allergies.
What is the most appropriate strategy in regards to prophylactic antibiotic therapy for this child?

Select one of the following:

  • Doxycycline + Metronidazole PO

  • Amoxicillin PO

  • Co-amoxiclav PO

  • Flucloxacillin PO

  • No antibiotic prophylaxis required

Explanation

Question 4 of 4

1

A 28 year old man presents to A&E after being bitten on his left forearm by a pet dog at home. The wound is open and bleeding. He says he was bitten half an hour ago.
On examination, he is alert, although distressed and in some pain. The wound itself is bleeding slightly, and it does not appear to run deeper than the epithelium. All other examinations are normal. All observations are within the normal parameters. He has a past medical history of asthma which is poorly controlled. He says he is allergic to penicillin.
What is the most appropriate strategy in regards to prophylactic antibiotic therapy for this patient?

Select one of the following:

  • Doxycycline + Metronidazole PO

  • Erythromycin PO

  • Co-amoxiclav PO

  • Gentamicin PO

  • No antibiotic prophylaxis required

Explanation

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