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Flashcards in GetAhead Specialities EMQs Deck (32)
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1

What elevation of only alpha-fetoprotein alone may mean?

Break in a fetal skin → neural tube defect (e.g. spina bifida) or anencephaly

*further testing/imaging is needed to confirm spina bifida

2

What age of gestation do we perform: 

a) amniocentesis

b) chorionic villus sampling

a) amniocentesis →15 weeks and above

b) chorionic villus sampling → 11- 14 weeks

 

*both tests are diagnostic - they will give definitive answer if a condition is present 

3

What's a 'low risk 'ovarian cyst and what to do?

  • USS: unilateral, simple, <5 cm
  • normal Ca 125

 

Conservative management, if an asymptomatic patient 

Repeat scan in 3-4 months (as 50% ill resolve)

 

*high risk cysts -> opposite to above -> manage by surgical excision 

4

Patient >60 y old and new iron-deficiency anaemia. What to do?

Urgent colorectal cancer pathway referral

5

Examples of live attenuated vaccines (7)

 

  • BCG
  • MMR
  • oral polio
  • yellow fever
  • oral typhoid
  • oral rotavirus
  • intranasal influenza

 

These to be avoided if a patient is on immunosuppressive treatment / immunocompromised 

6

What are adverse features of patients with tachycardia?

Following ABC assessment, patients are classified as stable/unstable according to the presence of aby adverse signs: 

- syncope

-shock: BP <90, pallor, sweating, confused/impaired consciousness, cold. clammy extremities 

- heart failure 

- myocardial ischaemia 

 

If any of the above signs are present → give DC synchronised shock (synchronised cardioversion) 

 

7

What levels of fasting glucose indicate impaired glucose regulation/pre-diabetes? 

6.1-6.9 mmol/l

42-47 mmol/mol

8

What's Lemmiere's syndrome?

Lemierre's syndrome:

  • infective thrombophlebitis of the internal jugular vein
  • caused by Fusobacterium necrophorum
  • it is a complication of a throat infection when it spreads through the tissues in the neck to cause an infected blood clot
  • this can cause sepsis as well as embolism to the lungs

9

Hypertension treatment - 4 steps

10

What's recommendation of Rx of DKA (dose)?

A fixed rate IV insulin infusion of 0.1 units/kg/hour

11

What symptoms can deficiency of each vitamin ADEK cause?

  • Vitamin A: poor night vision and general vision
  • Vitamin D: poor bone and muscle strength
  • Vitamin E: myopathies, neuropathies, ataxia
  • Vitamin K: easy bruising

12

1st line Rx for: 

  • generalised seizures 
  • focal seizures 

Generalised: Sodium Valproate 

Focal: Carbamazepine

13

Treatments (1st and 2nd line) for general tonic-clonic seizures

1st line: sodium valproate 

2nd line: lamotrigine, carbamazepine

14

Drug treatment for absence seizures

Absence seizures* (Petit mal)

  • sodium valproate or ethosuximide
  • sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy

15

What anti-convulsive (1) drug may exacerbate absence seizure and myoclonic seizures? 

Carbamazepine 

16

17

When in gestation can CTG be used?

From 32 weeks gestation 

 

*measures foetal HR and uterine activity 

18

What's normal range of foetal HR?

110-160 beats/min

19

20

The labour triad of passages

  • power → uterine contractions
  • passage → birth canal
  • passenger → the foetus

21

When is the pregnant uterus palpable?

From 12 weeks

22

Anatomical location of the pregnant uterus in:

  • 20 - 22 weeks
  • by 36 weeks

  • 20 - 22 weeks → reaches the umbilicus
  • by 36 weeks → lies under the ribs

23

What elements must be determined in obstetric palpation?

  • number of foetuses 
  • lie (longitudinal, oblique or transverse)
  • presentation (cephalic or breech)
  • engagement
  • measure symphysis-fundal height (from 16 weeks, this will increase approx 1cm/week)
  • auscultate the heart (Doppler USS from 12 weeks, Pinard stethoscope from 24 weeks)

24

If the SROM (spontaneous rupture of membranes) is suspected, do we do vaginal examination?

No, it is better to do speculum exam (to avoid the infection)

25

What's an absolute contraindication to the manual vaginal exam?

Placenta Previa

26

What's the most preferable position of baby's presentation at labour?

Occipitoanterior

27

How do face and brow presentation (labour) look like?

  • brow is the least common presentation (1 in 2000) → it may delay 2nd stage of labour (head is required to rotate - otherwise its diameter is too large to pass through pelvis) 

 

  • face occurs 1 in 500 → it can delay engagement and progress; also it may lead to facial oedema

28

Risk factors for breech presentation

  •  multiparity 
  • bony pelvic abnormalities
  • uterine abnormalities
  • fetal prematurity (insufficient time to rotate)
  • multiple pregnancies
  • fetal abnormality
  • extended legs
  • oligo/polyhydroamnios
  • placenta previa

29

External Cephalic Version (ECV)

  • when can be performed
  • contraindications to ECV

  • performed at 37 weeks

 

  • contraindications: previous CS, Hx of antepartum haemorrhage, multiple pregnancies, oligo/polyhydroamnios, placenta previa

30