more extra bits

Question 1

Endometriosis - what are good questions to ask about symptoms

Answer 1

Pain during sex
Pain during periods

Question 2

Management of endometriosis for
(a) pain
(b) fertility

Answer 2

(a) NSAIDs and hormonal contraceptives
(b) refer to fertility clinic, may need surgery

Question 3

what cancer can gynaecomastia be present in

Answer 3

testicular cancer

• therefore check for testicular lumps, hCG and AFP levels in bloods

Question 4

what gestational age can termination of pregnancy be done until?

Answer 4

24 weeks

Question 5

when is medical and surgical termination of pregnancy offered usually

Answer 5

1. medical <10 weeks
2. surgical >10 weeks

Question 6

what is considered ‘higher’ risk for Down’s syndrome and can be offered diagnostic tests (amniocentesis and chorionic villous sampling - both are diagnostic tests)

Answer 6

chance greater than 1 in 150

Question 7

what is chorionic villous sampling

Answer 7

takes sample from placenta

Question 8

what is amniocentesis

Answer 8

needle into the amniotic sac to take a sample

Question 9

what is the risk of diagnostic down’s screening tests (i.e. amniocentesis and chorionic villous sampling)

Answer 9

miscarriage

Question 10

what should you do in a patient with pressure sores

Answer 10

1. Regular checking of skin
2. Foam mattresses
3. Reposition every 4-6 hours
4. Dietary advice for good healing of sores
5. Safeguarding referral if needed

Question 11

What are the 3 options of medications for atrial fibrillation rate control

Answer 11

1. b-blocker e.g. bisoprolol
2. CCB e.g. diltiazem
3. digoxin

Question 12

If a patient with AF has had it for <48 hours, the treatment is cardioversion. If they have had the symptoms for >48hrs, what do you need to do before cardioversion (either with DC or amiadorone)?

Answer 12

Anticoagulate for 3 weeks first

Before doing DC cardioversion or pharmacological cardioversion (i.e. with amiadarone)

Question 13

chronic fatigue syndrome needs to have symptoms for at least…

Answer 13

3 months

Question 14

effect of NSAIDs on heart failure

Answer 14

can exacerbate fluid retention - stop NSAIDs!

can have topical or paracetamol instead

Question 15

how should you take levothyroxine

Answer 15

empty stomach with water
30-60 mins before breakfast

Question 16

orlistat - what is the criteria for continuing this for weight loss

Answer 16

> 5% wt loss in 12 weeks
otherwise stop it

Question 17

INR target for atrial fib/ one-off PE/VTE

Answer 17

2.5

Question 18

INR target for recurrent PE/ recurrent VTE

Answer 18

3.5

Question 19

what does a non blanching rash means

Answer 19

does not turn white when pressed
e.g. meningitis!

Question 20

from what age can a teenager consent to vaccinations without parents

Answer 20

from age 16

Question 21

are there any recommendations for meningitis prophylaxis for school contacts

Answer 21

no - only household contacts

Question 22

febrile seizures - what % have one more,
and what % develop into epilepsy

Answer 22

15% have 1 more
5% develop into epilepsy

Question 23

what % of recurrences of febrile seizures occur in the first year

Answer 23

70%

Question 24

what form is it for the palliative care/fast track funding

Answer 24

SR1 form

Question 25

when does achilles tendinopathy need urgent same day ortho referral

Answer 25

tendon rupture i.e. sudden pain, or positive Thompson test

Question 26

what is the women's domestic abuse charity

Answer 26

women's aid

Question 27

where do we refer for grave's disease eye disease and new grave's diagnosis

Answer 27

endo and opthal

Question 28

what investigations are we doing for hyperthyroidism

Answer 28

Bloods - thyroid ECG Thyroid USS

Question 29

what medication are we giving for hyperthyroid symptoms

Answer 29

propranolol or diltiazem CCB if asthmatic

Question 30

what investigations do we do for noctural enuresis

Answer 30

urine MCS renal USS

Question 31

what contraceptions should be stopped at age 50

Answer 31

COCP Injection

Question 32

what conctraceptions can be continued after age 50

Answer 32

IUS mirena coil POP Implant

Question 33

when do we need to stop contraception

Answer 33

>50 years with LMP >1 year ago <50 years with LMP >2 years ago

Question 34

what is treatment for angioedema or acute hives

Answer 34

6 weeks of antihistamines then review refer to allergy clinic for angioedema

Question 35

bell's palsy treatment

Answer 35

prednisolone - within 72hr of onset

Question 36

does bell's palsy affect the forehead

Answer 36

YES

Question 37

when do you refer bell's palsy

Answer 37

>3 weeks - to ENT > 3 months - to plastics

Question 38

shingles when to treat and what with

Answer 38

acyclovir - within 72hours of onset

Question 39

chronic prostatis treatment

Answer 39

1. Self-help and educate 2. Analgesia for pain 3. LUTS - trial of tamsulosin 4. Abx for max 6 weeks as a trial 5. Pelvic floor exercises - refer to physio 6. Refer to urology if no improvement

Question 40

Is tuberculosis a notifiable disease

Answer 40

YES

Question 41

When to offer prophylaxis for genital herpes

Answer 41

only if more than 6 recurrences per year

Question 42

If patients' relatives or welfare attorney disagree with DNACPR, what can you do?

Answer 42

Offer second opinion If persists, can take this to Court of Protection to decide

Question 43

Hepatitis A - how long to stay off work/school after symptom onset

Answer 43

7 days also no sex, wash hands, notify local Health Unit for contact tracing

Question 44

TIA symptoms that resolved in the last 7 days, what do you treat this with?

Answer 44

300mg aspirin urgent 24hr referral to TIA clinic

Question 45

TIA symptoms, resolved, occurred >7 days ago, what is the treatment

Answer 45

No aspirin Urgent referral to TIA clinic

Question 46

Hypercalcaemia Cough

Answer 46

SARCOIDOSIS

Question 47

Androgenic alopecia a.k.a ....?

Answer 47

male pattern baldness - make sure you check bloods to rule out physical causes.

Question 48

what is the treatment for androgenic alopecia (male pattern baldness)

Answer 48

topical minoxidil wigs etc - refer for any other treatments (finasteride is off-license)

Question 49

Alopecia areata (caused by autoimmune diseases so check bloods) - what is the treatment

Answer 49

Topical potent steroid creams Most grows back! Reassure patient.

Question 50

what is a severe flare up of crohn's or ulcerative colitis - when are we admitting to hospital!

Answer 50

over 6 stools per day

Question 51

what IBD worsens with smoking

Answer 51

crohn's disease

Question 52

how often are familial adenomatous polyposis patients needing colonoscopies

Answer 52

ANNUALLY! make sure they all have had genetic referrals, even those aged <18 years

Question 53

treatment for gambling

Answer 53

refer to counselling Gambling Anonymous groups National Gambling helpline

Question 54

treatment for insomnia

Answer 54

CBT for insomnia!

Question 55

smoking cessation options

Answer 55

nicotine varencline - not for CKD bupropion - not for epilepsy or low mood

Question 56

treatment for actinic keratosis

Answer 56

2-3 week course of 5-FU + topical hydrocortisone after to help with irritation if no improvement come back for derm referral

Question 57

when are we repeating U+Es to check for: (a) AKI improvement (b) CKD diagnosis

Answer 57

(a) repeat in 2 weeks (b) repeat in 90 days

Question 58

after starting statins what do we expect to see

Answer 58

after 3 months, we want non-HDL cholesterol to be decreased by 40%

Question 59

treatment of asthma in kids under 5 years old

Answer 59

1. SABA + low dose ICS regularly 2. Stop and review after 3 months 3. If ongoing symptoms, restart low dose ICS + SABA (can increase to moderate dose) 4. Add on LTRA 5. refer to specialist

Question 60

treatment of asthma in kids aged 5-12 years

Answer 60

1. SABA + low dose ICS PRN 2. SABA + low dose ICS regularly 3. consider low dose MART 4. add on LTRA 5. refer to specialist

Question 61

what test in examination for de quervian's tendosynovitis

Answer 61

finklestein's test hand in a fist (thumb inside the palm)

Question 62

what analgesia is ok in breastfeeding

Answer 62

paracetamol ibuprofen + NSAIDs

Question 63

when a patient has asthma in the exam, what am i not prescribing them

Answer 63

NSAIDs b-blocker!!!!

Question 64

what analgesia is not allowed in pregnancy

Answer 64

NSAIDs codeine just give paracetamol.

Question 65

no contact sports for how long with glandular fever

Answer 65

1 month

Question 66

how to explain haemorrhoids

Answer 66

swollen dilated veins around the rectal area

Question 67

when to refer a neck lump on 2ww

Answer 67

present for >3 weeks

Question 68

what 2 medications do we give for peripheral arterial disease

Answer 68

clopidogrel statins

Question 69

what medication to give instead of verapamil with b-blockers

Answer 69

give amlodipine instead avoid exercise, monitor for bradycardia/low BP

Question 70

what is the treatment for hirsuitism

Answer 70

topical eflournithine