Last Blast

Question 1

Vaccination schedule?

Answer 1

Question 2

Gross Motor milestones? [+]

Answer 2

Question 3

Developmental milestones: speech and hearing? [+]

Answer 3

Question 4

Developmental milestones: speech and hearing ?

Answer 4

Question 5

Developmental milestones: social behaviour and play?

Answer 5

Question 6

Turns towards sound ?

Answer 6

Turns towards sound - 3 months

Question 7

At what age would the average child acquire the ability to good pincer grip?

Answer 7

Good pincer grip - 12 months

Question 8

At what age would the average child acquire the ability to tower of 3-4 blocks?

Answer 8

Tower of 3-4 blocks - 18 months

Question 9

At what age would the average child acquire the ability to sits without support

Answer 9

7-8 months

Question 10

knows own name? [1]

Answer 10

12 months

Question 11

At what age would the average child acquire the ability to smiles?

Answer 11

6 wekeks

Question 12

combines two words? [1]

Answer 12

2 years

Question 13

At what age would the average child acquire the ability to waves ‘bye-bye’?

Answer 13

12 months

Question 14

At what age would the average child acquire the ability to walks unsupported?

Answer 14

13-15 months

Question 15

A 28-year-old in her first pregnancy has a spontaneous vaginal delivery at term, followed by post-partum haemorrhage, just after the placenta is delivered. The doctor managing the emergency asks the midwife to check for placental integrity.
Regarding placental anatomy, which one of the following statements is true?
Question 1 Answer

a.
It originates from the inner cell mass of the blastocyst

b.
Its thickness at the centre is ~ 4 cm

c.
A spiral artery usually supplies 3-4 cotyledons

d.
It contains 15-20 cotyledons

Answer 15

It contains 15-20 cotyledons

Question 16

Where specifically does the placenta originate from? [1]

Answer 16

The placenta originates from the outer cellular layers in the blastocyst, that is the trophoblast

Question 17

Placental thickness is highest at the centre and is usually ~ [] cm

2.5
3.5.
4.5
5.5
6.5

Answer 17

Placental thickness is highest at the centre and is usually ~ [] cm

2.5
3.5.
4.5
5.5
6.5

Question 18

Placental thickness ≥[] cm is often pathological
- What could this be caused by? [1]

Answer 18

Placental thickness ≥4 cm is often pathological
- Placental thickness ≥4 cm is often pathological, especially in the context of pre-existing or gestational diabetes mellitus

Question 19

What are the functional units of the placenta? [1]
What do each contain? [1]
How many are there? [1]

Answer 19

A term placenta contains ~ 15-20 cotyledons.
- Each cotyledon contains 3-4 stem villi, that are the functional units of the placenta.

Question 20

What is each cotyledon is usually supplied by? [1]

Answer 20

Each cotyledon is usually supplied by a single spiral artery.

Question 21

Pregnancy test is based on urinary detection of hCG. It can detect a pregnancy from [] days after implantation

Answer 21

Pregnancy test is based on urinary detection of hCG. It can detect a pregnancy from 7-10 days after implantation

Question 22

. In case of complete miscarriage, in the absence of PV bleeding or abdominal pain, a home pregnancy test is usually advised after [] weeks.

Answer 22

. In case of complete miscarriage, in the absence of PV bleeding or abdominal pain, a home pregnancy test is usually advised after 3 weeks.

Question 23

A 37-year-old in her fourth pregnancy at 17 weeks’ gestation and with a previous history of two early miscarriages, attends A&E complaining of PV leaking. The leakage is pinkish and watery. A speculum examination confirms amniotic fluid pooling in the posterior fornix and a bedside ultrasound scan shown a single viable fetus with anyhydramnios.
Which one of the following is the most critical function
Question 3 Answer

a.
Fetal swallowing

b.
Forms a hydrostatic wedge which helps cervical dilatation

c.
Protects from cord compression during contractions

d.
Allows free movements to fetus

e.
Transfer of nutrients and water

Answer 23

Fetal swallowing

Question 24

he most critical function of the amniotic fluid at this stage of gestation is fetal swallowing. Why? [2]

Answer 24

Ingestion of amniotic fluid and passage within the fetal lungs is an essential trigger for development during the canalicular phase of lung maturation (18-25 weeks).

It is also critical for development of the GIT.

Question 25

Which of heparin / LMWH crosses the placenta? [2]

Answer 25

Many drugs administered to the mother will cross the placenta (exceptions include LMWH but not heparin)

Question 26

ccording to the SPIKES framework, two of the most critical aspects of communication upon delivering unexpected news are: S, space P, perceptions. Describe what these are [2]

Answer 26

ccording to the SPIKES framework, two of the most critical aspects of communication upon delivering unexpected news are: **S, space (physical and non-physical) to connect and join the patient**, and **P, perceptions, to understand what her perceptions are** (hence asking questions) and what is her language, in order to be able to align with that while delivering the news.

Question 27

Which stage of the ovulation cycle has variable length? [1]

Answer 27

The **pre-ovulatory phase of the menstrual cycle** (also known as **follicular** or proliferative phase) has **variable duration,** while the **post-ovulatory phase is rather fixed, as the lifespan of a corpus luteum is of 14 days.**

Question 28

The vestible is the anatomical space enclosed by the []

Answer 28

The vestible is the anatomical space enclosed by the **labia minora**

Question 29

A 21-year-old is reviewed at GP practice due to curdy vaginal discharge, dyspareunia, and generalised soreness in the genital area, which is worsen by urination. Upon examination, the GP notices redness and tenderness in the vestibular area. Which one of the following is the correct anatomical definition of ‘vestibule’? Question 8 Answer a. The inner faces of the labia minora b. The lower end of the vulval introitus c. The anatomical space between the vulva and the anus d. The blind upper end of the vagina e. The anatomical space including the vaginal introitus, the urinary meatus, and the clitoris

Answer 29

**The anatomical space including the vaginal introitus, the urinary meatus, and the clitoris**

Question 30

Which ligament collects blood during c-section? [1]

Answer 30

The **broad ligament is composed by two sheets of peritoneum**. It extends from the lateral pelvic wall on both sides and folds over the internal female genitalia covering their surfaces anteriorly and posteriorly. It also includes parametrial tissues, vessels, lymphatics, and nerves. **This ligament is prone to collect bloods when complex caesarean sections are carried out with lateral extensions.**

Question 31

The [] ligament is a band of fibrous tissue which keeps the uterus in position during pregnancy.

Answer 31

The **round ligament** is a band of fibrous tissue which keeps the uterus in position during pregnancy.

Question 32

33-year-old lady in her second pregnancy and with a history of previous caesarean section undergoes an emergency caesarean section in labour due to suspected fetal compromise. A transverse lower segment uterine incision is carried out, which is complicated by extension and collection of blood (haematoma) within one of the uterine ligaments. Which ligament is most likely to be involved? Question 9 Answer a. Infundibulo-pelvic ligament b. Broad ligament c. Meso-ovarian ligament d. Cardinal ligament e. Round ligament

Answer 32

Broad ligament

Question 33

Describe the uterine body-cervix ratio during infant, reproductive age and post-menapausal [3]

Answer 33

The uterine body -cervix ratio is 1:1 during infancy, 2:1 during during reproductive age, and goes back to 1:1 in post-menopause as the uterus becomes atrophic.

Question 34

What is the version angle? [1]

Answer 34

The **version angle** is between the **long axis of the cervix and the vagina**.

Question 35

A 32-year-old lady is referred to a gynaecologist due to a 6-month history of pelvic pain, dysmenorrhea, and dyspareunia. Her sexual health screening is negative. A transvaginal ultrasound reveals a retro-verted uterus and multiple adhesions suggestive of endometriosis. Regarding uterine anatomy, which of the following statement is correct? Question 11 Answer a. An anteverted uterus has a version angle greater than 90 degree b. The uterine body-cervix ratio is 2:1 in post-menopause c. The version angle is between the long axis of the cervix and the vagina d. 80% of uteri are axial or retroverted e. Each `Fallopian tube meet the uterus at the infundibulum

Answer 35

A 32-year-old lady is referred to a gynaecologist due to a 6-month history of pelvic pain, dysmenorrhea, and dyspareunia. Her sexual health screening is negative. A transvaginal ultrasound reveals a retro-verted uterus and multiple adhesions suggestive of endometriosis. Regarding uterine anatomy, which of the following statement is correct? Question 11 Answer a. An anteverted uterus has a version angle greater than 90 degree b. The uterine body-cervix ratio is 2:1 in post-menopause c. **The version angle is between the long axis of the cervix and the vagina ** d. 80% of uteri are axial or retroverted e. Each `Fallopian tube meet the uterus at the infundibulum

Question 36

*able to visualise the superior limbus* What does this most likely indicate? [1]

Answer 36

**This patient has lid retraction** - and this is indicated by being able to visualise the superior limbus which is never visible in normal people. If chemical hyperthyroidism is identified, he can be diagnosed with **Grave's disease.**

Question 37

Which anti-TB drugs increase the risk of gout? [2]

Answer 37

Anti-tuberculous treatment with **pyrazinamide and ethambutol** is known to reduce renal urate excretion and precipitate particularly troublesome attacks of gout. Given the timing, this is the most likely cause in this case

Question 38

What is a key risk for thrush (that isn't DM) [1]

Answer 38

A key risk factor for candidiasis is **combined oral contraceptive use.** Oestrogen in the pill can alter the vaginal environment, making it more conducive for fungal growth.

Question 39

A patient may be detained in hospital by a nurse under section 5(4), which lasts for only **[]** hours. What is the time for 5(2)? [1]

Answer 39

A patient may be detained in hospital by a nurse under section 5(4), which lasts for only **6 hours.** Section 5(2): **72hrs**

Question 40

Patients with MI secondary to cocaine use should be given [] as part of acute (ACS) treatment

Answer 40

Patients with MI secondary to cocaine use should be given **IV benzodiazepines** as part of acute (ACS) treatment

Question 41

Side effects of ciclosporin? [5]

Answer 41

Ciclosporin side-effects: everything is increased - **fluid, BP, K+, hair, gums, glucose**

Question 42

[] is contraindicated in G6PD deficiency

Answer 42

**Ciprofloxacin** is contraindicated in G6PD deficiency

Question 43

[] can cause postural hypotension

Answer 43

**Doxazosin** can cause postural hypotension

Question 44

Why should you give alpha blockers with caution to those having cataracts surgery? [1]

Answer 44

**Caution** should be exercised in patients who are having cataract surgery due to the risk of **intra-operative floppy iris syndrome**

Question 45

What blood test would reveal paracetamol OD? [1]

Answer 45

**A transaminitis (elevated ALT and AST) in the 10,000s** is most commonly caused by paracetamol overdose.

Question 46

Widened QRS or arrhythmia in tricyclic overdose - give []

Answer 46

Widened QRS or arrhythmia in tricyclic overdose - give **IV bicarbonate**

Question 47

A 24-year-old man presents to his local emergency department at 4 am. He reports that he took 32 x 500mg tablets of paracetamol at 4 pm the previous evening following an argument with his partner. He reports feeling well at present but wants 'to be checked out'. He is stable. What is the next management?

Answer 47

Paracetamol overdose: if presentation 8-24 hours after ingestion of an overdose of more than 150 mg/kg start acetylcysteine even if the plasma-paracetamol concentration is not yet available

Question 48

What problems may long-term amiodarone use cause? [2]

Answer 48

Amiodarone, a class III antiarrhythmic drug, contains iodine and can induce both **hypothyroidism** and **thyrotoxicosis** due to its effect on thyroid function.