Difficult Past Questions Flashcards
(141 cards)
1
Q
Vitamin deficiency in hyperemesis gravidarum
A
Thiamine (B1) deficiency
2
Q
14 year old primary with amenorrhoea + ejection systolic murmur
A
Turner’s
3
Q
Cyclical pain, no heavy menstrual bleed, never sexually active
A
Ovarian cyst
4
Q
What do you test for in Hep B infection antenatally?
A
HBsAg
5
Q
At antenatal check, woman with BP 150/90, what would you do?
A
Admit and assess
6
Q
Women with previous GDM- what is the best way to investigation her blood glucose?
A
OGTT at 24-28 weeks
7
Q
What type of contraception can increase risk of osteoporosis?
A
Depo-Provera
8
Q
Women with excessive vomiting, under what circumstance would you admit her?
A
Ketonuria
also 5% weight loss and can’t tolerate oral antiemetics
9
Q
Infection causing azoospermia
A
Mumps orchitis
10
Q
Someone comes in at 28w with a Hb of 10.5 what would you do?
A
Oral iron
11
Q
Women with menopausal symptoms, hysterectomised, does not want to take oral tablets
A
Transdermal oestrogen HRT
12
Q
Painful multiple lesions on labia
A
Herpes
13
Q
Mother with stillborn baby, generalized oedematous when born, mother had fever at 18w with rash on trunk
A
Parvovirus B19
14
Q
Mother being prepared for CS, sudden tingling around her mouth?
A
Spinal block
15
Q
When should lose Moro Reflex?
A
4 months
16
Q
When should lose asymmetrical tonic neck reflex?
A
7 months
17
Q
When should lose palmar grasp reflex?
A
6 months
18
Q
When should lose upgoing plantars?
A
12 months
19
Q
What is rooting reflex?
A
Newborn infant will turn its head toward anything that strokes its cheek or mouth,
20
Q
When should lose rooting reflex?
A
4 months
21
Q
Strawberry tongue
A
Scarlet Fever
22
Q
Pruritus ani worse at night
A
Threadworm
23
Q
Treatment for pruritus ani worse at night
A
Mebendazole
24
Q
Impetigo treatment
A
Mild and localised: fucidic acid for 5 days
Widespread/bullous: flucloxacillin for 7 days
25
Scabies treatment
Permethrin cream
26
What age would refer if can't sit without support?
8 months (normally by 6)
27
What age would refer if can't walk?
18 months (normally by 15)
28
What age would refer if can't hop on one leg?
5 years (normally by 4)
29
What age would refer if can't pincer grip?
12 months (normally by 10)
30
What age would refer if can't smile?
8 weeks (normally by 6)
31
Benign tumour which responds well to NSAIDs initially
Osteoid osteoma
32
Posterior fossa tumour
Pilocytic astrocytoma or medulloblastoma (answer says medulloblastoma)
33
Rash that started from behind the ears and spread to trunk, parents are vegetarians and kid goes to school in north London
Measles
34
Scaphoid abdomen
Diaphragmatic hernia
35
When to refer somatisation to CAMHS?
- Stressors hard to relieve
- Serious family dysfunction
- Pain impairs functioning
36
Diagnosed bipolar disorder – sudden renal failure, what do you check?
Lithium levels
37
Someone is brought in by their mother to A&E and appears psychotic -- what section would you put them under?
Section 4
38
Treatment of dystonia
Procyclidine
39
Someone who lost her husband 7 months ago and started hearing voices of him saying to join him a month ago
Abnormal grief response
40
78yo guy has issues with organization, troubles with understanding words
Frontotemporal dementia
41
Learning Disability criteria
1. IQ < 70 (normal = 100)
2. Impact on daily living
3. Present before age 18
42
Who would you refer a schizophrenic patient to if they are being discharged and needs support in the community regarding treatment?
Community psychiatric nurse
43
Drug that acts on 5HT receptors
LSD/MDMA
44
Meaning of CIN II
Moderate dyskariosis
45
20-week antenatal scan, which is best description:
- Tests nuchal translucency
- Least amount of radiation
- 2D with foetal biometry
- Multiple pregnancies
2D with foetal biometry
46
Leading cause of maternal death in UK
Heart disease = pregnancy until 6 months postpartum
| Suicide = 1 year postpartum
47
Cause of inspiratory stridor since birth
Laryngomalacia
48
Kid takes 4 benzodiazepine tablets 4 hours ago. Currently asleep but was GCS 15 a few hours ago. Next step?
Admit for monitoring
| IV flumenazil reverses CNS depression
49
Kid recently started solids, now constipated. No faecal masses felt in abdomen.
Increase fluid intake
50
Old woman is anxious as increasingly forgetful -- thinks she has dementia
Depression
51
Treatment of nappy rash with satellite lesions
Clotrimazole
52
Treatment of nappy rash with flexural sparing
Zinc barrier cream
53
2 foetal poles, one gestational sac = what type of twin?
Monoamniotic
54
Posterior rib fractures
Non-accidental injury
55
Commonest type of endometrial cancer
Endometrial adenocarcinoma
56
Yellow-green vaginal discharge and pain
Trichomonas vaginalis
57
Child complains of unusual smell. Then "spaces out". After she's very drowsy and sleeps for a few hours. Can't remember what happened
Focal seizure
58
7yo who refuses to HW and plays Minecraft on iPad. Parents worried
Normal behaviour for age (?)
59
UTI treatment first trimester
1. Nitrofurantoin
| 2. Cefalexin
60
First test you do in amenorrhoea
b-hCG
61
Test to confirm premature ovarian failure
Increased FSG on 2 samples six weeks apart
62
Commonest cause of azoospermia
- Mumps
- Hx of testicular torsion
- Varicocele
Varicocele
63
Post-menopausal woman with a PV bleed. What ix should you do?
Outpatient US with endometrial biopsy
64
Asymptomatic woman, nulliparous, found to have a 5.4cm unilocular ovarian cyst on US, no fhx. Mgmt/Ix?
- USS guided cyst aspiration
- Laparoscopic removal of cyst
- Discharge and safety-net
- Rearrange USS in 3 months and Ca125 follow-up
Rearrange USS in 3 months and Ca125 follow-up
65
What causes increased urinary volume and frequency in the first trimester?
- Increased GFR
- Pressure of uterus on bladder
- Glycosuria
Increased GFR
66
SSRI effect on newborn
Persistent Pulmonary Hypertension of the Newborn
67
Woman with Nexplanon. Most likely reason for wanting to change contraceptive?
- Weight gain
- Acne
- Mood swings
- Irregular bleeding
Irregular bleeding
68
Woman with a slow growing painless lesion on labia
Genital warts
69
Woman with tender lump inside her vagina.
Bartolin’s cyst
70
Menopause option: woman with premature ovarian failure, wants to have periods
COCP
71
Small slow-growing lesion on labia, pregnant lady
Genital Warts (pregnancy causes them to grow)
72
Kid with history of anal fissure - what is your first course of action?
Inspect anal region
73
A-level student has recently come back from Nigeria, with symptoms of jaundice, mild anaemia and fever with malaise and arthralgia.
Malaria
74
Kid has pain in outer ear, ear was protruding outwards, and there was a lump behind his ear.
Mastoiditis
75
Kid with cervical lymphadenopathy, fever, sore throat, red tongue with white spots. What does she have?
Scarlet Fever (strawberry tongue)
76
4 month old, about to have 3 batch of primary vaccinations. Which would be a complete contraindication to having the vaccine?
- Confirmed history of pertussis as a baby
- Currently ill with a fever of 38.5
- Got a rash at site of last vaccination
- Severe cow’s milk allergy,
Currently ill with a fever of 38.5
77
Perianal itching especially at night. What’s the best treatment option?
Mebendazole = treats threadworm
78
Kid with URTI and generalised abdo tenderness
Mesenteric adenitis
79
Baby was born at 41 weeks via emergency C-section due to foetal distress. Needed ventilation straight away. X-ray showed hyper inflated lungs with areas of consolidation.
Meconium aspiration
80
Baby born at 37 weeks, via forceps. Showing signs of resp distress. CXR shows areas of consolidation throughout.
Group B Strep
81
80 year old man with new onset dementia, needs MRI but refuses. You need someone to make decision for him
- Talk to family with his permission
- Ask independent mental health advocate
Ask independent mental health advocate
82
Risk of schizophrenia if one parent has it
10% (twin = 50%)
83
What is high in anorexia nervosa?
Growth hormone
84
Man with treatment resistant schizophrenia on clozapine, recently stopped smoking. High level of clozapine now. Most likely consequence?
Seizures (agranulocytosis is not dose-dependent!)
85
Man perceives objects to be smaller than they are
Micropsia
86
Technical term for feel insects under skin
Formication
87
Woman is pregnant and HIV negative at booking but her partner is HIV positive - what do you do?
Nothing
88
Results show azoospermia. How should they be managed?
- IVF
- Egg donation
- ICSI
- IUI
ICSI = Intracytoplasmic Sperm Injection
89
Definition of onset of active first stage of labour
Cervix 4cm dilated and regular contractions
90
Tamoxifen increases risk of this cancer
Endometrial
91
3 months old baby with signs of HF, systolic murmur that radiates over the precordium
VSD
92
What is the most important thing to look at in follow up of HSP?
Urine protein and RBCs
93
6 year old child with 24 hour history of left peri-orbital swelling. Had an upper respiratory tract infection last week. Left proptosis, visual acuity was normal and had a fever of 38.9. What is the best diagnostic investigation?
CT of nasal orbits
94
Child in A&E with asthma attack, was given puffs of salbutamol. Now has a quiet chest, what do you do next?
Call for senior help
95
Child with fever, white exudate on one tonsil
Quinsy (peritonsillar abscess)
96
Mother complains her young child is a fussy eater. She eats soft foods and drinks a lot of milk. Also has been feeling tired recently
Iron deficiency anaemia
97
Child suffers from fever. The fever disappears but she has now developed a blanching rash on trunk. She subsequently has febrile convulsions.
HHV6 (roseola infantum)
98
Kid with delayed milestones in language, GP clicked his fingers and she turned to look, what’s the next step?
- Refer for hearing assessment
- Refer to SALT
- Refer for developmental assessment
Refer for hearing assessment
99
Hypochloraemic hypokalaemic pH shown, with some clinical information. What is the initial management for it? -Correct electrolyte imbalance
- Surgical consult
- Abdominal USS
Correct electrolyte imbalance
100
3 year old kid with unilateral nasal discharge with bleeding and crust
Foreign body insertion
101
Unwell child where chest was clear, had a fever. Lost weight recently. What do you do next?
- CXR
- Urine dip,
- Glucose
- ABG
Glucose (always go with ABC DEFG approach as that’s what you do FIRST)
102
Neonate with some cardio problem. Systolic murmur loudest at the left sternal edge 2/6
VSD
103
Hip pain on exercise and climbing stairs. Prolonged history, otherwise well.
- Perthes disease
- Osgood-schlater
- Septic arthritis
Perthes Disease
104
Blue dots on cervix
Endometriosis (answers say Nabothian Cysts)
105
Sudden abdo pain, well child, something indentable on the L lower quadrant
Answer says Wilm’s Tumour
106
Kid with functional abdo pain associated with school. Best management:
- Encourage to go to school and come back when tummy starts to hurt
- Have her schoolwork sent home whilst she is having pains
- Change school
- Make her go to school regardless of pains
- Give her home tutoring
Encourage to go to school and come back when tummy starts to hurt
107
4 year old girl with a high fever that was followed by a rash which has small white dots on a red base. What is the most likely Dx?
Could be Roseola (fever first, then rash)
108
14 year old kid who thieves, gets into fights (basically conduct disorder). What is first-line management
- Multisystemic (family) therapy
- CBT
- DBT
- Psychodynamic therapy
Multisystemic (family) therapy
109
Uncle gets TB, kid lives with him. Mantoux test showed a number between 10-14mm for the result. What should you do?
- Watch and wait
- Give isoniazid prophylaxis
- Start anti-TB treatment
- Give BCG vaccine
Start anti-TB treatment (>5mm is positive if have TB contacts)
110
Definitive diagnostic test for precocious puberty?
- Bone age
- Gonadotropin stimulation test
- MRI scan of pituitary fossa
Gonadotropin stimulation test (apparently...)
111
Kid with hemiplegic weakness and brisk reflexes, what area of the brain is affected?
- Basal ganglia
- Pyramidal tracts
- Motor cortex
- Cerebellum
- Internal capsule
Motor cortex
112
Kid with rough rash on face & trunk, flushed face. No rash around mouth
Scarlet Fever (sandpaper rash)
113
HIV with undetectable viral load. What is contraindicated in labour?
- Forceps
- Ventouse
- Foetal blood sampling
- C-section
Foetal blood sampling
114
Woman with rupture of membranes and painless bleeding
Vasa praevia
115
17yr old girl wanting Emergency contraception more than 5 days after unprotected sex
Copper IUD
116
Contraception used soon after giving birth
POP immediately (IUS after 4 weeks)
117
Baby's head comes out but then goes back in
Shoulder dystocia
118
Woman had some intrauterine growth and endometrial thickness
Fibroids
119
Pregnant woman in early pregnancy with depression and anxiety on sertraline. What do you do?
- Stop sertraline
- Continue sertraline
- Prescribe high-dose folic acid
- Reduce the dose
- Amitryptylline
Continue sertraline
120
Post partum haemorrhage with high BP
- Carboprost
- Misoprostol
- Ergometrine
- Syntocinon
Syntocinon (ergometrine contraindicated in HTN)
121
Foetus with transverse lie, recent SROM -- now CTG shows foetal distress
Cord Prolapse
122
What’s the management for DVT risk in a pregnant woman who’s coming in for a planned cesarean?
- LMWH
- LMHW and Ted stockings
- Ted stockings
- Warfarin
- Aspirin and Ted stockings
LMHW and Ted stockings
123
Woman with raised testosterone and LH:FSH ratio 2:1
PCOS
124
Woman with blocked tubes on hysterosalpingogram, what treatment should you do for fertility?
- IVF
- IUI
- ICSI
IVF
125
Heavy periods in a girl not sexually active. What do you give her?
- COCP
- Mefenamic acid
- Transexamic acid
Transexamic acid
126
Poorly controlled diabetic mother, her newborn has an abnormal asymmetric Moro reflex - what’s wrong?
Brachial plexus injury
127
Woman on COCP, has missed 6th and 7th day pill, had unprotected sex two days ago, her urine pregnancy is clear. What to do?
Emergency contraception (also take most recent missed pill and extra precautions in next 7 days)
128
Woman with endometriosis, had laparoscopic adhesiolysis - had a whole range of sx - high CRP, low Hb, constipation, bowel sounds absents - what’s happened?
Perforation
129
Woman with offensive smelly lochia day 2 post-partum, had had some high vaginal swabs.
- Reassure and discharge
- Await swab results
- Give antibiotics
- Abdo USS
Give antibiotics
130
70yo with 2 post-menopausal bleeds, TVUS shows 6mm endometrium and 3 cm simple ovarian cyst. Next step?
- Ca125
- Diagnostic laparoscopy
- Pipelle
Ca125
131
MMSE cut-offs
24-30: normal
19-23: mild
10-18: moderate
0-9: severe
<21: increased dementia
132
Some girl with anorexia was admitted and she started eating and stuff. Then she gets muscle spasms, and abdominal pain. What electrolyte most deranged?
Calcium = muscle spasms
133
Someone else kicking off and de-escalation has failed, what drugs?
- Lorazepam
- Lorazepam + haloperidol
- Haloperidol
Lorazepam
134
Girl drops out of uni, goes back home lives with mother and blames mother for poisoning her
- Paranoid type disorder
- Schizoid personality disorder
- Acute psychosis
Acute psychosis
135
Woman blushes in public
Social phobia
136
Woman has been spending loads of money, lots of energy, little sleep, going on for 6 weeks but not affecting her work (although feels more imaginative)
Hypomania
137
Dude with LBD, given a drug that makes him worse
Haloperidol
138
People with learning disabilities coming in with carers/families and their carers/families disagreeing with the doctor’s plan -- what would you do first?
ALWAYS assess capacity- everyone is assumed to have capacity until proven otherwise
139
Dilated pupils, urinary retention, obs normal - cause of overdose?
- TCA
- Benzos
- Opioids
- SSRI
Benzos
140
What do you monitor with lithium?
Lithium, TFTs, U&E
141
Definitive diagnostic test of precocious puberty
GnRH Stimulation test (pre-pubertal respond poorly to GnRH, precocious respond well)
