Clinical Diagnosis & Management Flashcards

A 30-year-old woman presents with a 3-week history of low mood, anhedonia, poor sleep, fatigue, and difficulty concentrating. She denies suicidal ideation. PHQ-9 score is 14. What is the most appropriate initial management?

Answer: Psychoeducation, watchful waiting or low-intensity psychological therapy, and consider SSRI

A PHQ-9 of 10–19 indicates moderate depression. First-line management includes psychological therapies (CBT) and/or an SSRI, alongside psychoeducation and regular follow-up. Benzodiazepines are not antidepressants and should not be used routinely.

Which of the following is the recommended first-line antihypertensive for a 50-year-old Māori man with hypertension and no other comorbidities?

Answer: ACE inhibitor or angiotensin receptor blocker

ACE inhibitors or ARBs are recommended as first-line antihypertensives for adults under 55 (or those with diabetes, CKD, or heart failure). They also provide renal protection. In Māori patients, cardiovascular risk is assessed using the NZ CVD risk calculator.

A 4-year-old is brought in with a 5-day fever, rash, conjunctival injection, cracked lips, and cervical lymphadenopathy. What is the most likely diagnosis?

Answer: Kawasaki disease

Kawasaki disease requires at least 5 days of fever plus 4 of 5 features: rash, conjunctival injection, oral changes (cracked lips, strawberry tongue), lymphadenopathy, and extremity changes. It is treated with IVIG and aspirin to prevent coronary aneurysms.

Which of the following is most consistent with a diagnosis of irritable bowel syndrome (IBS)?

Answer: Abdominal pain relieved by defecation, altered stool form, no red flag symptoms

IBS is a functional gut disorder characterised by abdominal pain related to defecation, altered stool frequency and form, without red flag features (bleeding, weight loss, nocturnal symptoms, anaemia). Organic causes must be excluded first.

A patient presents with an acute gout flare affecting the right first metatarsophalangeal joint. What is the most appropriate first-line treatment?

Answer: NSAIDs (e.g., naproxen) or colchicine

NSAIDs or colchicine are first-line for acute gout flares. Allopurinol should NOT be started during an acute flare as it can prolong the attack; it is initiated 2–4 weeks after the flare resolves.

Which blood test is most useful for monitoring response to iron replacement therapy?

Answer: Reticulocyte count at 1–2 weeks

Reticulocyte count rises within 7–10 days of starting iron therapy, providing early evidence of bone marrow response. Haemoglobin improvement typically takes 4–6 weeks. Reticulocytosis is the earliest reliable indicator of treatment response.