Master Specialist Public Health Medicine (COM5551)
for DHA Speciality

A 34-year-old woman at 28 weeks' gestation attends the antenatal clinic with a 3-day history of dysuria, urinary frequency, and suprapubic discomfort. She is afebrile, blood pressure 108/68 mmHg, pulse 84/min, and urine dipstick shows nitrites and leucocytes. She has no allergies and a normal renal function (eGFR >90 mL/min/1.73 m?). She is otherwise well and has no history of recurrent urinary tract infection. What is the most appropriate first-line antibiotic?

A 62-year-old man with type 2 diabetes and a 10-year history of hypertension presents to his GP with a 2-week history of productive cough, fever, and pleuritic chest pain. He is a non-smoker. Vital signs: temperature 38.4?C, respiratory rate 24/min, blood pressure 118/74 mmHg, oxygen saturation 93% on room air. Chest X-ray shows right lower lobe consolidation. His CURB-65 score is 1. He has no allergies and his renal function is normal. What is the most appropriate management?

A 45-year-old woman presents to a sexual health clinic with a 5-day history of vaginal discharge and vulval itching. She is not pregnant, has no allergies, and her last menstrual period was 2 weeks ago. Speculum examination shows a thick white discharge and vulval erythema. Vaginal pH is 4.0, and microscopy shows budding yeast cells and pseudohyphae. She has no history of recurrent candidiasis and no immunosuppression. What is the most appropriate first-line treatment?

A 70-year-old man with chronic kidney disease stage 4 (eGFR 22 mL/min/1.73 m?) presents with a 3-day history of painful, red, swollen left leg. He is afebrile, blood pressure 138/82 mmHg, pulse 88/min. Doppler ultrasound confirms a proximal deep vein thrombosis. He has no active bleeding and no history of heparin-induced thrombocytopenia. What is the most appropriate initial anticoagulant?

A 28-year-old woman presents to her GP with a 2-week history of low mood, anhedonia, and poor sleep. She has no suicidal ideation and no past psychiatric history. She is 10 weeks pregnant. She has no allergies and takes no regular medication. What is the most appropriate first-line management?