mock paper Q's

Question 1

what are the doses of adrenaline to be given in anaphylaxis for 8 year old boy?

Answer 1

300 micrograms IM adrenaline 1:1000 (0.3ml)

Question 2

what are the doses of adrenaline to be given for an 18 month old baby?

Answer 2

150 micrograms IM adrenaline 1:1000 (0.15ml)

Question 3

what are the doses of adrenaline to be given to an adult?

Answer 3

> 12 years - 500 micrograms IM adrenaline 1:1000 (0.5ml)

Question 4

what us the risk of a patient with foot pain at rest with dusky coloured skin, and absent pulses of needing a lower limb amputation?

Answer 4

25% risk of death in 1 year
33% risk of lower limb amputation

Question 5

what is the clinic target BP for patient with HTN and T2DM?

Answer 5

140/90 - previous targets have now been superseded by one clinic target of 140/90 for everyone < 80 years old

150/90 > 80 yrs

Question 6

how do you measure ABPI?

Answer 6

highest recorded systolic BP in the affected leg over the highest recorded systolic pressure in either arm

Question 7

what are the amber flags for sepsis in children?

Answer 7

not responding normally to social cues - no smile, decreased activity, wakes only with prolonged stimulation

nasal flaring
tachypnoea - > 50 bpm in 6-12 months, > 40 bpm in over 12 months
O2 < 95%, crackles on chest

Tachycardia:
>160 beats/minute, age <12 months
>150 beats/minute, age 12-24 months
>140 beats/minute, age 2-5 years
* Capillary refill time >=3 seconds
* Dry mucous membranes
* Poor feeding in infants
* Reduced urine output

fever > 5 days
age 3-6 months with fever > 40
rigors
swelling of limb or joint

Question 8

what are some red flag features of sepsis in children?

Answer 8

pale, mottled skin

appears ill to healthcare professional
does not wake on stimulation
weak, high pitched cry

tachypnoea > 60
moderate intercostal/severe recession

reduced skin turgor

< 3 months with > 38 degree temp

• Age <3 months, temperature >=38°C
• Non-blanching rash
• Bulging fontanelle
• Neck stiffness
• Status epilepticus
• Focal neurological signs
• Focal seizures

Question 9

should abx be prescribed to a child with fever with no obvious source?

Answer 9

no - only if suspect meningiococcal sepsis can give IM benpen but no routine abx

Question 10

what is the dose of IM benpen for suspected meningitis in community for < 1 years old?

Answer 10

IM 300mg

Question 11

what is the dose of IM benpen for suspected meningitis in community 1-10 years old?

Answer 11

IM 600mg

Question 12

what is the dose of IM benpen for suspected meningitis for > 10 years old?

Answer 12

1200mg IM

Question 13

what is the management of one off episode of haematuria in a child with no symptoms?

Answer 13

repeat dipstick in 1 week - one off episode of microscopic haematuria in a child during an illness is common and usually resolves

Question 14

what temp indicates high risk (red flag) sign for sepsis in 2 month old?

Answer 14

> 38 degrees

Question 15

what temp indicates high risk (red flag sign) for sepsis in > 3 month old?

Answer 15

no temp indicates red flag
temp > 39 - intermediate (amber) RF for serious illness

Question 16

what is the management of head lice in children?

Answer 16

Dimeticone 4% lotion and spray, malathion 0.5% lotion and wet combing

Question 17

what is the honey and mumford questionnaire?

Answer 17

questionnaire used to define the preferred learning style that can help witht he selection of educational experiences that suit that style

Question 18

what are the learning styles identified in honey and mumford questionnaire?

Answer 18

activists
reflectors
theorists
pragmatists

Question 19

what is the belbin inventory?

Answer 19

questionnaire which identifies the nine types of personalities that seemed to be important in teams

Question 20

what is the calgary-cambridge observation guide?

Answer 20

The (enhanced) Calgary–Cambridge guide to the medical interview is a useful guide that can be used when analysing Dr/patient consultations. It considers how we provide structure within the consultation and allows in depth analysis of the following areas within the consultation, expanding on these to enable more effective communication. It describes the five tasks of the consultation as initiating the session, gathering information, building the relationship, giving information – (explaining and planning) and closing the session.

Question 21

what is collaborative care?

Answer 21

working with the patient and their family to define solutions to problems - collaborative care has shown improvement in MUS and reduced health care utilisation costs

Question 22

what is reattribution?

Answer 22

technique which tests the thoughts and assumptions of patients by considering alternative causes of events. This particularly helps to challenge beliefs held by people who perceive themselves as the cause of problem events

Question 23

what is psychodynamic therapy?

Answer 23

Psychodynamic therapy draws on theories and practices of analytical psychology and psychoanalysis. It is a therapeutic process which helps patients understand and resolve their problems, helping individuals to unravel, experience and understand their true, deep-rooted feelings in order to resolve them.

Question 24

at how many weeks from the onset of symptoms would you investigate fatigue with no other symptoms?

Answer 24

approx 4 weeks

Question 25

how long can you safely use a potent corticosteroid in one area of skin in plaque psoriasis?

Answer 25

8 weeks continuously

Question 26

what is the management of chronic plaque psoriasis?

Answer 26

first line - potent corticosteroid + vit D OR vit D analogue for 4 weeks, can be extended to 8 weeks max. second line - if no suitable clearance after 8 weeks, offter vit D analogue or a vit D analogue alone applied twice daily

Question 27

for how long should very potent corticosteroids be applied in psoriasis?

Answer 27

for 4 weeks and only with specialist input

Question 28

how long should you have breaks between treatment of potent or very potent corticosteroids in plaque psorasis?

Answer 28

4 weeks between courses of treatment

Question 29

how long can potent steroids be used on the scalp?

Answer 29

8 weeks

Question 30

how long and what type of steroids can be used for psoraisis affecting the face, flexues or genitals?

Answer 30

only a mild-moderate steroid can be used for no more than 2 weeks

Question 31

which is the most common type of BCC?

Answer 31

Nodular BCC - accounts for 60-80% of all cases, commonly found on the face and neck, nodular with pearly rolled edges, with a central depressed/ulcerated area

Question 32

which virus increases the risk of laryngeal cancer?

Answer 32

HPV

Question 33

what is the paradise criteria?

Answer 33

criteria for tonsillectomy in recurrent tonsillitis - more than 7 yearly more than 5 yearly over 2 consecutive years more than 3 years over 3 successive years

Question 34

what is the most common pathogen in otitis externa?

Answer 34

aspergillus

Question 35

which treatment for ear wax is NOT licensed by NICE?

Answer 35

manual syringing

Question 36

what is the standardised mortality ratio?

Answer 36

SMR - ratio of observed deaths to expected deaths, multipled by 100. I.e. AN SMR of 100 means the number of deaths is the same as expected for the general population. A number higher than 100 implies an excess mortality rate.

Question 37

what would the SMR rate be if it is ten times that of the general population?

Answer 37

10 x 100 = 1000

Question 38

what is relative afferent pupillary defect?

Answer 38

If afferent impulses on the right side are delayed (due to, for instance, optic neuritis) as light is swung into the affected eye the consensual dilation from the (normal) left eye is more powerful than the light reflex in the affected eye. Therefore, paroxysmal dilatation is seen on the swinging light test in the affected (i.e., the right) eye. This phenomenon is best demonstrated with the light shone into the eyes alternately for 2–3 seconds with approximately one second in between.

Question 39

what is the serious eye complication in classical GCA?

Answer 39

ischaemic optic neuropathy - caused by occlusion of the short psoterios ciliary arteries

Question 40

what is the percentage cure rate for patients with Hep C antiviral treatment?

Answer 40

95%

Question 41

which is the most common muscular dystrophy?

Answer 41

myotonic dystrophy

Question 42

what is the inheritance of myotonic dystrophy?

Answer 42

autosomal dominant

Question 43

what are the symptoms of myotonic dystophy?

Answer 43

The disease is slowly progressive and is characterised by cataract formation, hypogonadism, frontal balding and cardiac disorders. As well as weakness, there is myotonia of involved muscles, the latter resulting in an inability of the patient to let go of the examiner’s hand.

Question 44

when does duchennes muscular dystrophy present?

Answer 44

aggressive disease that presents in first 5 years of life and usually leads to death by 20 years .

Question 45

how is duchennes muscular dystrophy inherited?

Answer 45

x-linked

Question 46

what is the most significant prognostic indicator for breast cancer prognosis?

Answer 46

axillary LN positivity

Question 47

which medication should be avoided in methotrexate?

Answer 47

the most serious complication of methotrexate therapy is bone marrow suppression, hence the need for regular blood monitoring with a full blood count. The concomitant use of an anti-folate drug (e.g. trimethoprim) increases the risk of bone marrow suppression, and should therefore be avoided, especially for prolonged treatment courses.

Question 48

which is the most common testicular neoplasm in over 50 years?

Answer 48

non hodgkins lymphoma

Question 49

what is the most common testicular neoplasm in 20-60 years?

Answer 49

leydig cell tumours

Question 50

what age can sertoli tumours present in the testes?

Answer 50

any age including infants

Question 51

what are the conditions which should be reported to the Injuries, Disease and Dangerous Occurances Regulations 2013?

Answer 51

Carpal tunnel syndrome Cramp of the hand or forearm Occupational dermatitis Hand arm vibration syndrome Occupational asthma Tendonitis or tenosynovitis Occupational cancer Exposure to a biological agent

Question 52

what is the Carr-Hill formula?

Answer 52

the Carr-Hill allocation formula used to adjust the global sum total for a number of local demographic and other factors which may affect Practice workload. for example, a Practice with a large number of elderly patients may have a higher workload than one which primarily cares for commuters.

Question 53

what is the time limit for a practice to acknowledge a complaint?

Answer 53

3 working days

Question 54

when is the most appropriate day of a womans cycle to take a mid-luteal phase serum progesterone?

Answer 54

Ovulation can be confirmed retrospectively by measurement of serum progesterone in the mid-luteal phase, approximately day 21 of a 28-day cycle. Women with fertility problems and prolonged regular menstrual cycles should be offered a later serum progesterone measurement e.g. day 28 of a 35-day cycle.

Question 55

when can a mirena coil be inserted after delivery of baby?

Answer 55

Levonorgestrel-intrauterine device (LNG-IUD) can be inserted within 48h of delivery, or after four weeks post-partum, given the risk of ascending bacterial infection and uterine perforation. Risk is deemed to be higher in breast feeding so sexual health clinics may wait up to 3 months.

Question 56

what are the fitness to fly rules in pregnancy?

Answer 56

most airlines do not allow travel after 36 weeks for a single pregnancy and after 32 weeks for a multiple pregnancy

Question 57

what is the only licensed antidepressant for PTSD?

Answer 57

sertraline

Question 58

what is the antidepressant of choice in patients on warfarin, heparin or NSAID's?

Answer 58

mirtazapine - lowest bleeding risk

Question 59

which medications are contraindicated in lithium?

Answer 59

NSAID's - reduce the excretion of lithium and increase the risk of toxicity

Question 60

what is the target HBA1c in patients with T2DM?

Answer 60

if managing with lifestyle only - 48 if managing with medications - 53

Question 61

first line antiemetic in EOL care of patient with bowel obstruction?

Answer 61

hyoscine butylbromide

Question 62

in a child who has survived a primarycancer, which is the single most common site of a subsequent primary cancer?

Answer 62

brain + thyroid

Question 63

what are the classes of BMI?

Answer 63

Overweight: BMI greater than 25 kg/m2 Obesity class 1: BMI of 30–34.9kg/m2 Obesity class 2: BMI 35 kg/m2 to 39.9 kg/m2 Obesity class 3: BMI 40 kg/m2 or more.

Question 64

what is the criteria for ref to genetic services in patient with breast cancer?

Answer 64

Bilateral breast cancer Male breast cancer Ovarian cancer Jewish ancestry Sarcoma in a relative younger than age 45 years Glioma or childhood adrenal cortical carcinomas Complicated patterns of multiple cancers at a young age Paternal history of breast cancer (two or more relatives on the father's side of the family)

Question 65

what is the MRC dyspnoea scale?

Answer 65

The modified Medical Research Council (mMRC) dyspnoea scale: 0. Not troubled by breathless except on strenuous exercise 1. Short of breath when hurrying on a level or when walking up a slight hill 2. Walks slower than most people on the level, stops after a mile or so, or stops after 15 min walking at own pace 3. Stops for breath after walking 100 yards, or after a few minutes on level ground 4. Too breathless to leave the house, or breathless when dressing/undressing

Question 66

what urine specimen is considered gold standard for chlamydia testing?

Answer 66

first catch urine vulvovaginal swab is the specimen of choice in women are most sensitive

Question 67

when should a repeat test be offered to young people under the age of 25 years with chlamydia?

Answer 67

after 3 months -This guidance is based on evidence that young adults who test positive for chlamydia are 2–6-times more likely to have a subsequent positive test, and that repeated chlamydia infection is associated with an increased risk of complications such as pelvic inflammatory disease and tubal infertility. A test-of-cure, however, is not routinely recommended for uncomplicated genital chlamydia infection.

Question 68

how long an ulipristal acetate be used for emergency contraception?

Answer 68

up to 120 hours after unprotected sex

Question 69

what should be done during BLS of a woman > 20 weeks pregnant?

Answer 69

If the woman is known to be 20 weeks' pregnant or more, then inferior vena cava (IVC) compression may occur and it should be relieved either by manually displacing the uterus to the left (pulling or pushing depending on the side of the patient) with one or two hands (keeping the chest supine) or by tilting the mother (head to toe) to the left (15–30 degrees) provided she is on a firm surface (e.g. tilting table or spinal board), so that the efficacy of chest compressions is not compromised.