Mock 2

Question 1

What is the initial treatment for DKA in a child with N+V?

Answer 1

IV Fluids (0.9% NaCl 10ml/kg) and SC Insulin (0.1units/kg/hr)

Question 2

Describe bicarbonate levels in DKA

Answer 2

Low as the ketones use them all up

Question 3

Describe creatinine levels in DKA

Answer 3

Mildly raised - sign of dehydration

Question 4

Describe features of Stephen-Johnson Syndrome

Answer 4

Rare but serious - affects multiple parts of the body. Begins with flu-like symptoms followed by red/purple target like rash that spreads and forms blisters

Question 5

Give some common causes of Stephen Johnson syndrome

Answer 5

Allopurinol
Lamotragine
Penicillin
Phenytoin
Viral infection (mumps, flu, HSV, EBV)

Question 6

What is always the appropriate first step when considering a diagnosis of epilepsy?

Answer 6

Request an EEG - Don’t start medication until you know what subtype of epilepsy they have

Question 7

Give 4 complications of chicken pox

Answer 7

Bacterial superinfection
Cerebellitis
DIC
Progressive Disseminated Disease

Question 8

Describe impetigo rash

Answer 8

Small pustules that develop a honey-coloured crusted plaque, usually on face, no surrounding erythema, often not itchy

Question 9

Give 4 high risks of future suicide after a failed attempt

Answer 9

Leaving a note
Taking precautions to avoid discovery
Terminating utility contracts
Using a violent method e.g. jumping/hanging

Question 10

What class of drugs is used to prevent and treat extra-pyramidal side effects caused by antipsychotics?

Answer 10

Anti-cholinergics e.g. procyclidine

Question 11

What drug is used to treat tardive dyskinesia?

Answer 11

Tetrabenazine

Question 12

Give a drug used to reverse the effects of LMWH

Answer 12

Protamine sulphate

Question 13

Give a drug used for symptomatic management of myasthenia gravis

Answer 13

Pyridostigmine

Question 14

What is the first line treatment for PTSD

Answer 14

Trauma focussed CBT

EMDR if ineffective

Question 15

What class of drug is citalopram?

Answer 15

SSRI

Question 16

What does a PHQ score of 5-9 mean

Answer 16

Mild depression

Question 17

What does a PHQ score of 10-14 mean

Answer 17

Moderate depression

Question 18

What does a PHQ score of 15-19 mean

Answer 18

Moderately severe depression

Question 19

What does a PHQ score of 20-27 mean

Answer 19

Severe depression

Question 20

What is the intervention for mild depression?

Answer 20

Watch and wait - consider referral to IAPT for low intensity psychological interventions

Question 21

Are obsessive thoughts usually egosyntonic or egodystonic?

Answer 21

Obsessive thoughts are usually egodystonic (very different to the patient’s normal beliefs and values) rather than egosyntonic (in keeping with ones beliefs and values)

Question 22

Give 4 medications associated with delirium?

Answer 22

Furosemide
Oxybutinin
Propanolol
Rantidine

Question 23

How often should a patient commenced on clozapine have their blood tested?

Answer 23

Every week for 18 weeks

Then fortnightly until 1 year

Question 24

Miss Sahli, a 29-year-old lady, had a positive urinary pregnancy test 6 weeks ago. She presents to your GP surgery complaining of blood coming from her vagina. You suspect she may be having a threatened or inevitable miscarriage. A transvaginal ultrasound is carried out which shows an intrauterine fetal pole with no fetal heartbeat. The crown rump measurement is less than 7mm. What is the next most appropriate step?
A. Inform the mother that she has had a miscarriage
B. Repeat the Ultrasound in 7 days
C. Give IM Methotrexate and monitor beta HCG levels
D. Discharge the patient with no further follow-up as a viable pregnancy is likely
E. Prepare for immediate surgical evacuation of the retained products of conception

Answer 24

B is correct as due to the Crown rump length being less than 7mm, it may be too early to tell whether this is viable but very early pregnancy, or a possible non-viable pregnancy (miscarriage). A repeat scan is necessary.

Question 25

If a patient is hrHPV positive and analysis reveals CIN1, what should you do?

Answer 25

Do not treat, Discharge and screen again at 12 months in the community. Individuals with CIN 1 have low grade abnormal changes in the transformation zone, they are at lower risk of developing cervical cancer so are often not treated but still need follow up after 12 months and further colposcopy if necessary.

Question 26

What is the most common type of vaginal cancer?

Answer 26

Secondary (metastatic) vaginal cancer (80%) - primarily from cervix or endometrium

Question 27

What is the most common type of primary vaginal cancer?

Answer 27

Squamous cell carcinoma

Question 28

Describe the correct process of faetal descent through the birth canal

Answer 28

Descent, engagement, flexion, internal rotation, crowning, extension of presenting part, external rotation of head, delivery DEFICEED

Question 29

How should asymptomatic bacteriuria on first culture be managed in pregnant women?

Answer 29

Confirm presence of bacteriuria with 2nd culture and then begin culture dependent antibiotic

Question 30

At what amniotic fluid index (AFI) would a pregnancy be diagnosed with polyhydramnios?

Answer 30

Greater than 24cm

Question 31

At what amniotic fluid index (AFI) would a pregnancy be diagnosed with oligohydramnios?

Answer 31

Less than 5cm

Question 32

What is the most common cause of polyhydromnios?

Answer 32

Idiopathic (50-60%)

Question 33

What kind of stroke are personality changes associated with?

Answer 33

Anterior cerebral artery stroke

Question 34

What is Horner's syndrome characterised by?

Answer 34

1. Unilateral anhydrosis (not sweating) 2. Enophthalmos (inset eye) 3. Miosis 4. Ptosis

Question 35

What is a common exam cause of Horner's syndrome?

Answer 35

Pancoast (apical) tumour compressing the sympathetic chain

Question 36

What is the only licensed treatment for MND?

Answer 36

Riluzole

Question 37

What are the triggers for migraines?

Answer 37

``` CHOCOLATE: Chocolate Hangover Orgasm Cheese OCP Lie in Alcohol Tumult Exercise ```

Question 38

How does ropinirole work?

Answer 38

Activates dopamine receptor s to mimic the action of dopamine

Question 39

What should you always give in addition to aspirin?

Answer 39

A PPI

Question 40

What should be prescribed for fibroids greater than 3cm whilst definitive treatment is arranged?

Answer 40

Tranexamic acid and/or NSAIDs

Question 41

83. Which of the options below is not a role of metformin in PCOS? A. Appetite reduction B. Decreases androgen production C. Decreases LH from the anterior pituitary D. Decreases sex-hormone binding globulin in the liver E. GnRH antagonist

Answer 41

GnRH antagonist

Question 42

85. A 6-year-old (20kg) is brought in to the emergency department by his parents. He weighs 20kg, is clinically dehydrated, tachypnoeic, but not shocked. His breath smells like pear drops. You carry out some basic investigations and discover that his blood glucose is 20 mmol/l, arterial pH is 7.2 (assume 5% fluid deficit) and there is ketonaemia. After 200ml of bolus, what is the most appropriate fluid resuscitation in this patient's current state? A. 0.9% NaCl plus KCl 40mmol/L, at a rate of 79ml/hour B. 0.9% NaCl plus KCl 40mmol/L, at a rate of 95ml/hour C. 0.9% NaCl plus KCl 20mmol/L, at a rate of 79ml/hour D. 0.9% NaCl plus KCl 20mmol/L, at a rate of 95ml/hour E. 0.9% NaCl plus dextrose, at a rate of 86ml/hour

Answer 42

For most paediatric cases 20ml/kg bolus is administered in shock, however in DKA and HF give 10ml/kg bolus due to fluid overload complications, eg. cerebral oedema. Estimated weight = (age +4)x2. For non-shocked patients with DKA: Hourly rate = ({Deficit – initial bolus} / 48hr) + Maintenance per hour If they were shocked and in DKA then you would not minus the initial bolus. Workings: - 5% deficit of 20kg: - 1kg is 1000ml water - (20x1000) x 0.05=1000ml deficit - 1000 deficit - 200ml bolus = 800ml to be given over 48h - 16.67ml/hr for 48h - Maintenance per 24h: - 100ml/kg for the first 10kg - 50ml/kg for the second 10kg - 20ml/kg for the third 10kg - 100x10=1000 - 50x10=500 - 1500ml to be given over 24h - 62.5ml/hr for 24h - Total: - 16.7 + 62.5 = 79.2 kg/h for 48 hours Fluid choice: - “Use 0.9% sodium chloride with 20 mmol potassium chloride in 500 ml (40 mmol per litre) until blood glucose levels are less than 14 mmol/l “ - You would also want to administer IV insulin, but only start this 1-2 hours after administering IV therapy.