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Navigating the Emotional Landscape of MRCPCH Part 2 Preparation

15/09/2025 6:29 am15/09/2025 4:48 pm

Recall. A 5-month-old baby passed the neonatal hearing screening, but came with parental concern about hearing. What is the best test to be done? Our Popular Courses

Recall. A 5-month-old baby passed the neonatal hearing screening, but came with parental concern about hearing. What is the best test to be done?

Recall . A 5 months old baby passed the neonatal hearing screening, came with parental concern about hearing. What is the best test to be done?
OAE
ABR
Visual evoked potential
Distraction test
Pure tone audiometry

Review Explanation

Ans- B

Explanation

Key facts in the question:

Age: 5 months old.
Passed neonatal hearing screening (so no major congenital hearing loss detected at birth).
Now parents are concerned — could be late-onset or progressive hearing loss.
We need the best test for this age group.

Understanding the options:

Test	What it measures	Age suitability	Notes
OAE (Otoacoustic Emissions)	Outer hair cell function in cochlea	Any age, quick screening	Good for screening, but if concern is high, we need a diagnostic test
ABR (Auditory Brainstem Response)	Electrical activity from cochlea to brainstem	Any age, gold standard for infants	Can detect sensorineural hearing loss, even if mild; not dependent on cooperation
Visual evoked potential	Visual pathway function	Not relevant for hearing
Distraction test	Behavioral response to sound	Reliable from ~6 months to 2 years	Baby is too young (5 months) for accurate results
Pure tone audiometry	Behavioral hearing test	From ~4–5 years	Not suitable for infants

Key reasoning:

At 5 months, behavioral tests like distraction test are not yet reliable.
Since there is parental concern, we need a diagnostic rather than a screening test.
ABR is the gold standard for confirming hearing loss in infants — it’s objective, works at any age, and can detect even mild losses.
OAE is useful for screening, but ABR is preferred here because the baby already passed newborn screening and now has new concerns — we need to check the entire auditory pathway.

✅ Best answer: B. ABR (Auditory Brainstem Response)

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AKP: Adolescent Health/Medicine

Recall helps us to increase our knowledge

1 / 11

= Recall

Female adolescence presented with abdominal tenderness, recurrent vaginal discharge, dysuria and post-coital bleeding. She has been sexually active in the last 2 years. What is the most probable diagnosis? (Select one answer only)

A. PID.

B. Chlamydia trachomatis

C. Ectopic pregnancy.

D. UTI.

E. Candida albicans.

Explanation

Chlamydia trachomatis

Overview

Organism: Chlamydia trachomatis (obligate intracellular bacterium)
Epidemiology: Most common bacterial STI in the UK; highest prevalence in sexually active <25 years
Transmission: Sexual contact, vertical (perinatal)

Clinical Features

Often asymptomatic (especially in women)

Women:

Vaginal discharge (mucopurulent)
Intermenstrual or post-coital bleeding
Lower abdominal pain
Dysuria
Cervicitis (inflamed, friable cervix)
Fever (if ascending infection)

Men:

Urethral discomfort
Watery urethral discharge
Dysuria
Epididymo-orchitis (less common)

Complications

Women:
- Pelvic Inflammatory Disease (PID)
- Tubal factor infertility
- Ectopic pregnancy
- Chronic pelvic pain
Men:
- Epididymitis
- Reactive arthritis (Reiter’s syndrome)
Neonates (vertical transmission):
- Conjunctivitis (5–14 days after birth)
- Pneumonitis (staccato cough, tachypnoea)

Investigations

NAAT (nucleic acid amplification test) – first-line
- Women: vulvovaginal swab (self-taken or clinician-taken)
- Men: first-catch urine sample
Consider screening for other STIs (gonorrhoea, HIV, syphilis)

Management

First-line:
- Doxycycline 100 mg PO twice daily for 7 days (≥14 years, non-pregnant)
Alternative (pregnancy / doxycycline contraindicated):
- Azithromycin 1 g PO stat, then 500 mg OD for 2 days
Partner notification and treatment
Abstinence from sexual activity until both patient and partner(s) have completed treatment

Prevention

Safe sex education
Condom use
Opportunistic screening in sexually active <25 years

Exam tip:
post-coital bleeding + abdominal pain + young sexually active female → think Chlamydia or PID. Always link to risk of infertility in the stem.

Recall: 16 yrs old, sexually active for 2 years, presented with dysuria, vaginal discharge, temp- mildly high 37.5, Supra pubic tenderness on examination, postcoital bleeding for the first time. Diagnosis:

a.Candida

b.Chlamydia

c.UTI

d.TSS

Ans- b

2 / 11

= Recall

14 years old girl with anorexia nervosa BMI 13 during ECG became drowsy and sweaty. What is your diagnosis. (Select one answer only)

A. Hypoglycemia

B. Hyperglycemia

C. Hypokalemia

D. Hyperkalemia

E. Hypocalcemia

3 / 11

= Recall

13-year-old girl with anorexia nervosa and BMI of less than 14.5. Serum K is 3.4. Which of the following is a high-risk sign? (Select one answer only)

A. Tympanic temp < 35.5 C.

B. BMI <18.

C. QT < 400.

D. BP 80/60.

E. Hypokalaemia 3.4.

Explanation: a) Tympanic temp < 35.5 °C

Option	Comment
a) Tympanic temp < 35.5 °C ✅	Hypothermia is a recognised high‑risk sign — even without other abnormalities.
b) BMI < 18	This is underweight but not a high‑risk threshold — many healthy adolescents have BMI < 18.
c) QT < 400	Short QT is not a danger sign here; prolonged QT is the concern.
d) BP 80/60 ✅	Hypotension (especially systolic < 80) is a high‑risk sign.
e) Hypokalaemia 3.4	Mild — high‑risk threshold is usually < 3.0 mmol/L.

Correct high‑risk sign in this list: a) Tympanic temp < 35.5 °C and d) BP 80/60 — both are considered high‑risk in anorexia nervosa.

Key takeaway:
In anorexia nervosa, vital sign instability (hypothermia, hypotension, bradycardia) and severe electrolyte derangements are more urgent red flags than mild biochemical changes or moderate underweight.

High‑Risk Signs in Anorexia Nervosa

Category	High‑Risk Threshold	Why It’s Dangerous
BMI	< 13–14 (varies by guideline)	Indicates severe malnutrition and high risk of organ failure
Heart rate	< 40 bpm (bradycardia)	Risk of arrhythmia, sudden cardiac death
Blood pressure	Systolic < 80 mmHg OR postural drop > 20 mmHg	Poor perfusion, cardiovascular collapse risk
Temperature	Core temp < 35.5 °C	Hypothermia → metabolic slowdown, cardiac instability
Electrolytes	K⁺ < 3.0 mmol/L, phosphate < 0.5 mmol/L, Mg²⁺ < 0.5 mmol/L	Arrhythmias, refeeding syndrome risk
ECG	QTc > 450 ms	Ventricular arrhythmia risk
Other	Rapid weight loss (>1 kg/week), syncope, severe dehydration	Signals acute physiological instability

Exam tip:

Mild abnormalities (e.g., K⁺ 3.4, BMI 17) are not usually “high‑risk” in MCQs — look for vital sign instability or severe biochemical derangements. If more than one high‑risk sign is present, urgent hospital admission is often indicated.

Mnemonic: "BRAVE POT" Think of needing to be BRAVE when facing the POTential dangers of severe anorexia.

Letter	Stands for	High‑Risk Threshold
B	Bradycardia	HR < 40 bpm
R	Really low BP	Systolic < 80 mmHg or postural drop > 20 mmHg
A	Abnormally low temp	Core temp < 35.5 °C
V	Very low BMI	< 13–14 (depending on guideline)
E	Electrolyte disturbance	K⁺ < 3.0 mmol/L, phosphate < 0.5 mmol/L, Mg²⁺ < 0.5 mmol/L
P	Prolonged QTc	> 450 ms on ECG
O	Ongoing rapid weight loss	> 1 kg/week
T	Troubling symptoms	Syncope, severe dehydration, confusion

How to use it in exams:
If you see a patient with anorexia nervosa and any of the BRAVE POT signs, think urgent admission or close monitoring.

4 / 11

= Recall

RED flag in anorexia nervosa for admission? (Select one answer only)

A. Orthostatic change in BP of 18 mmhg

B. BMI of 78th centile

C. HR 48 bpm

D. Tympanic temp of 35.3’C

E. Hypokalemia

5 / 11

= Recall

Anorexia nervosa, what will point to against another diagnosis? (Select one answer only)

A. Abdominal pain

B. Amenorrhea

C. Bradycardia

D. High cortisol and hypokalemia

E. Wearing baggy clothes

6 / 11

= Recall

Parents of a teenage girl who is diagnosed as anorexia nervosa, are concerned about her low weight gain and excessive exercise, despite that she started to attend CBT, she has amenorrhea for 6 months O/E: She looks thin & pale, HR 70, Supine BP- 115/60, when she stands BP 105/60. What is the next appropriate action Now ? (Select one answer only)

A. Family therapy

B. Nutrition optimization

C. Exercise restriction

D. Admit the girl

E. Hormonal therapy

7 / 11

= Recall

16 year-old girl with anorexia nervosa started on dietetic management and is gaining weight moving from the 3rd to the 9th centile and trying hard to take three meals per day with restriction of her daily activity and exercise to 1 hour per day. She had a regular cycle but has a 6 month history of amenorrhea. She started her menarche at 13 years old. A DXSA scan was done and it showed a decrease in her bone density. What is the treatment option that would best improve her bone density? (Select one answer only)

A. Vit D supplement

B. Vit C supplement

C. Estrogen & progesterone treatment

D. Increase weight-bearing exercise

E. Continue to increase caloric intake to increase the weight

8 / 11

= Recall

15 years old boy with progressive weight loss & poor appetite over the last 6 months, height of 9 th centile, very active in school activities and sports. He has good school performance and is otherwise normal. FBC electrolytes are normal. Normal bowel habits. (Select one answer only)

A. DM

B. Anorexia nervosa

C. Hypothyroid

D. celiac

E. Bulimia nervosa

9 / 11

= Recall

14 years old girl known case of DM type 1, she is difficult to handle and her parents want her to take more responsibility for her daily life glucose control, she has lost 2.3 kg in 3 months, from the history mother said she is skipping meals and previously ordered laxatives for a constipation for 4 days she also has occasional vomiting, her HbA1c was high 58 and now increased to 76. What is the most likely cause of her weight loss? (Select one answer only)

A. Eating disorder

B. Non-adherence to insulin treatment

C. Hypothyroidism

D. Hyperthyroidism

E. Insulin resistant

10 / 11

= Recall

A 16 year old female moved recently to the UK and came to see you as she wants to get the HPV vaccine, she wants to go on holiday with her boyfriend.

What advice would you give her? (Select one answer only)

Correct answer C. She will need 1 dose of the vaccine

Summary advice for this patient:
She can receive one dose of the HPV vaccine now, even if she is sexually active, without pregnancy testing or antibody testing, and without waiting after other vaccines. Here’s a quick comparison of the UK HPV vaccination schedule — how it’s evolved from the older multi‑dose approach to the current streamlined one.

Current UK Schedule (as of 2023)

Healthy individuals aged 12–25: 1 dose of Gardasil 9. Immunocompromised individuals: 3‑dose schedule (0, 1–2, and 6 months)

UK HPV Vaccine Schedule — Old vs. New

Period	Eligible Group	Standard Schedule	Notes
2008–2014	Girls aged 12–13 (Year 8)	3 doses at 0, 1, and 6 months	Catch‑up programme for girls up to 18 years old
2014–2022	Girls <15 years old	2 doses at 0 and 6–12 months	3 doses still used if starting ≥15 years or immunocompromised
2019	Programme extended to boys aged 12–13	Same 2‑dose schedule as girls	Part of universal HPV vaccination
Sept 2023 onward	All eligible adolescents up to age 25	1 dose for healthy individuals	3 doses only for immunocompromised or certain high‑risk groups

Why not the others?

"Contraindicated if sexually active" — Not true. Being sexually active is not a contraindication. The HPV vaccine can still protect against HPV types the person hasn’t yet been exposed to.
"Pregnancy test before vaccine" — Not required. HPV vaccination is not recommended during pregnancy, but routine pregnancy testing before vaccination is not advised.
"Cannot be given within 6 weeks of other live vaccines" — Not applicable. HPV vaccine is non‑live, so it can be given at the same time as, or any time before/after, other vaccines.
"HPV antibody should be tested first" — Not done. There’s no antibody test used to determine prior HPV exposure before vaccination.

Key Takeaways

Sexual activity doesn’t change eligibility — the vaccine still offers protection against HPV types not yet acquired.
No antibody testing or pregnancy testing is required before vaccination.
Non‑live vaccine — no need to space from other live vaccines.
Current UK guidance: Healthy 16‑year‑olds like your scenario patient now need just one dose for full protection.

LINK

**Exam Pearl

Sexually transmitted infection

helping all young people to protect themselves is a major public health issue
in England, sexually transmitted infections in heterosexuals are highest in 15–24 year olds
those under 25 years accounted for 63% of all new chlamydia cases in 2016
chlamydia is the most frequent STI diagnosis, followed by genital warts and gonorrhoea
the introduction of the HPV vaccinations in adolescent girls may potentially have had an impact on recent trends in new diagnoses of genital warts. This is now being offered to adolescent boys as well
in 2017, there was a reduction of 40% of new HIV diagnoses among those aged 15–24 years Reinfection with acute STIs is a particular problem with young people, but the risk decreases with increasing age.

Chlamydia causes an infection that is often symptomless but may be associated with vaginal bleeding, discharge, abdominal pain, fever and inflammation of the cervix in women and watery discharge from the penis in men. Long- term complications may be severe, particularly in women, as it can lead to pelvic inflammatory diseases, ectopic pregnancy and infertility.

Gonorrhoea has an incubation period of only a few days, and males and females may experience a urethral discharge. Women are at risk of long- term serious complications such as infertility and ectopic pregnancy and it is possible to have long- term infection without obvious symptoms. Syphilis has an incubation period ranging from a few days to 3 months. Symptoms are nonspecific, though illness usually begins with painless, highly infectious sores anywhere around the body but usually at the site of infection.

Genital warts are caused by the human papillomavirus (HPV) and are found around the penis, anus and vagina. Certain types of HPV are associated with cervical cancer and head and neck cancers. Warts often disappear without treatment but can also be removed by freezing, burning and laser treatment.

Genital herpes is a common infection caused by Herpes simplex virus type 2 or 1. Symptoms include small blisters in the genital area, which break down to give painful ulcers. Herpes may cause pain on urination.

11 / 11

= Recall

14 yrs girl have sex with 23 yrs boy came for OCP. (Select one answer only)

A. refer to social service

B. check understand of OCP

C. convince to tell parents

D. give OCP, she will continue sex anyway

E. call to police

MRCPCH Prep

Your score is

Option	Why Less Likely
Hyperglycemia	Would cause polyuria, thirst, not acute sweating + drowsiness in this context.
Hypokalemia	Can cause arrhythmias, weakness, but not sweating + acute neuro symptoms.
Hyperkalemia	Causes muscle weakness, arrhythmias; no sweating/drowsiness unless severe arrhythmia with collapse.
Hypocalcemia	Causes tetany, paresthesia, seizures; not classic for sweating + drowsiness.

Option	Typical in Anorexia Nervosa?	Notes
a. Abdominal pain	✅ Possible	Can occur due to constipation, delayed gastric emptying, or starvation effects.
b. Amenorrhea	✅ Common	Due to hypothalamic suppression from low body fat.
c. Bradycardia	✅ Common	Starvation slows metabolism and heart rate.
d. High cortisol & hypokalemia	❌ Not typical together	Cortisol may be mildly elevated from stress, but hypokalemia is not a hallmark unless there’s purging (vomiting/laxatives). Severe hypokalemia with high cortisol suggests other endocrine or metabolic disorders (e.g., Cushing’s, Conn’s, vomiting from bulimia).
e. Wearing baggy clothes	✅ Common	Often to hide weight loss.

Option	Why not best here
1. Vit D supplement	Only helps if deficient; not the primary driver of bone loss here.
2. Vit C supplement	No role in bone density improvement in this context.
3. Estrogen & progesterone treatment	In adolescents with anorexia, OCPs don’t significantly improve bone density; nutritional recovery is superior.
4. Increase weight-bearing exercise	Risk of worsening energy deficit and fractures before full recovery.
5. Continue to increase caloric intake	Best — addresses root cause (low energy availability, hypoestrogenism).

Option	Typical features	Fits this case?
a. Diabetes mellitus (DM)	Weight loss, polyuria, polydipsia, polyphagia, possible dehydration, abnormal glucose	No mention of thirst, urination, or abnormal glucose; electrolytes normal
b. Anorexia nervosa ✅	Adolescent, weight loss, poor appetite (or food restriction), often high achievers, may be very active, normal labs early on	Fits perfectly: active, good school performance, weight loss without systemic illness
c. Hypothyroidism	Weight gain (not loss), fatigue, constipation, poor school performance, bradycardia	Opposite pattern — not likely
d. Coeliac disease	Weight loss, poor growth, diarrhoea or abnormal stools, possible anaemia	Normal bowel habits and normal FBC make this less likely
e. Bulimia nervosa	Binge eating followed by purging, weight often normal or slightly low, dental erosion, electrolyte disturbances	No history of binge/purge behaviour; electrolytes normal

Navigating the Emotional Landscape of MRCPCH Part 2 Preparation