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1
Q

Patient in labour with pyrexia, suspected Group B strep infection. Give?

A

Benzylpenicillin as prophylaxis. Vancomycin if pen allergy

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2
Q

Symptoms of intussuseption and investigations?

A

Intermittent severe crampy abdo pain, drawing up of knees, bilious vomiting, red currant jelly blood stained stools

Can present in young or infants

Inv: ultrasound

Rx: air insufflation or surgery

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3
Q

Labial lump, pruritus, inguinal lymphadenopathy. Older female. Diagnosis?

A

Vulval carcinoma. May be bleeding secondary to ulceration

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4
Q

What is a Bartholin’s cyst?

A

Occlusion to Bartholin’s gland causing unilateral labial swelling. Can cause pain when walking and dyspareunia. Women of childbearing age.

UNLIKELY vulval itching which is more Lichen or vulval carcinoma

Bartholin’s glands secrete fluid that acts as a lubricant during sex

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5
Q

Presentation of an infected Bartholin’s cyst?

A

Bartholin’s or labial abscess. Acutely painful labial swelling with overlying erythema and systemic symptoms including fever. Inguinal lymphadenopathy
So fever, pain and erythema

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6
Q

Respiratory distress syndrome - presentation and risk factors?

A

Tachypnoea, intercostal recession, expiratory grunt, cyanosis. Ground glass opacification on CXR.
RFs: male, GDM, CS
Rx: prevention by corticosteroids, assisted ventilation, exogenous surfactant via ETT

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7
Q

7y/o presents with vulval/anal itching. Area erythematous from itching. Dx?

A

Threadworm - highly transmissible so ALL members of household should be treated.
Rx: single dose of mebendazole for the household and give hygiene advice

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8
Q

Treatment for GDM? Thresholds?

A

Do OGTT
If levels are >7 at time of diagnosis commence SHORT-ACTING insulin (for GDM it’s short acting)
If <7 then trial diet and exercise but if symptoms don’t improve in 1-2 weeks then metformin

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9
Q

Management of pre-existing DM in pregnant women?

A

Weight loss
Stop oral hypoglycaemics except metformin
Folic acid 5mg/day from pre-conception to 12 weeks gestation

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10
Q

When is VBAC appropriate?

A

For pregnant women >37 weeks with a SINGLE previous CS by low transverse incision

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11
Q

Presentation of Rickets?

A

Bow legs (younger children) and knock knees in older children. Kyphoscoliosis. Aching horned and joints. Bossing of forehead. Waddling gait.

Rickets describes inadequately mineralised bone in developing and growing bones, resulting in soft and easily deformed bones.

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12
Q

Paediatric BLS

A

Unresponsive
Open airway
5 rescue breaths then check for signs of circulation with brachial or femoral pulse
15:2 compressions

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13
Q

Causes of ambiguous genitalia neonates

A

Most common is congenital adrenal hyperplasia
Kallman’s - phenotypically male but have hypog hypog. No ambiguous genitalia
Androgen insensitivity syndrome - phenotypically female but no ambiguous genitalia

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14
Q

Rx of patent ductus arteriosus?

A

Indomethacin given to neonate in postnatal period, NOT TO MOTHER ANTENATALLY

Signs: L subclavicular thrill, MACHINERY MURMUR, collapsing pulse, heaving apex beat

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15
Q

Efficacy of emergency contraception?

A

Levonorgestrel - 72 hours after UPSI
Ulipristal - 96 hours after UPSI but CId with asthma
IUD - within 5 days of UPSI. If more than 5 days, then IUD can be fitted up to 5 days after the likely ovulation date

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16
Q

Symptoms of placental abruption with dilated pupils and brisk reflexes. Dx?

A

Cocaine abuse

DDx
HELLP syndrome - anaemia, low platelets
Heroin/opioid abuse - pinpoint pupils; not associated with abruption
Pre-eclampsia
DIC - rule out if clotting panel normal

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17
Q

Post-menopausal bleeding. What are you thinking?

A

Endometrial cancer. Other RFs for increased oesterogen: HRT, nulliparity, late menopause, early menses. We do not want unopposed oestrogen so addition of progestogen is important. Tamoxifen is an RF.

Inv: TVUS for endometrial thickness. If thickened, then hysteroscopy with endometrial biopsy

All women >55 with post-menopausal bleeding should be referred on 2WW for TVUS +- hysteroscopy with endometrial biopsy

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18
Q

Whooping cough presentation?

A

Paroxysmal cough, inspiratory whoop, post-tussive vomiting, apnoeic episodes
Dx: PCR and serology
Rx: infants <6 months admission with supportive care. Otherwise, macrolides eg erythromycin and household contacts given abx prophylactically.
School exclusion: 48 hours after abx or 21 days after onset if not given abx

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19
Q

Management of bacterial meningitis in paediatrics?

A

<3 months - IV amoxicillin & IV cefotaxime
>3 months - just IV cefotaxime. Consider dexamethasone if lumbar puncture reveals purulent CSF, high white cell count or bacteria on gram stain

Bacterial vs viral - petechial non-blanching rash indicates meningococcal meningitis

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20
Q

Child with fever and limp, complaining of hip pain after recent viral illness? Diagnosis?

A

Transient synovitis. Must refer a child with hip pain for same-day assessment to exclude septic joint.
Transient synovitis is self-limiting

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21
Q

Low birth weight is a risk factor for…?

A

Neonatal sepsis

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22
Q

Recurrent febrile seizures in children. Rx?

A

Buccal midazolam (benzodiazepine)
If that fails, then anticonvulsant like PO lamotrigine, phenytoin, PR carbamazepine

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23
Q

Palmar grasp milestone

A

6 months

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24
Q

Draws a circle milestone

A

3 years

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25
Tower of 3-4 blocks milestone
18 months
26
Causes of neonatal sepsis?
Group B strep Transmission of pathogens from environment post-delivery
27
Investigations for neonatal sepsis and management
Blood culture to establish diagnosis FBC Blood gases Urine MC&S Rx: Benpen with gentamicin (this is different o meningitis which is amoxicillin and cefotaxime for <6 months and just cefotaxime for >6 months)
28
CIs to COCP
>35 BMI>35 More than 15 cigarettes per day Family history of VTE Breastfeeding <6 weeks postpartum
29
Presentation of ovarian hyper stimulation syndrome?
Women undergoing ovulation induction Ascites, vomiting, diarrhoea
30
Patient has tubal ectopic pregnancy. Started on methotrexate but hCG titres fail to fall. Surgery is indicated. Which surgery?
NICE guidelines recommend that a salpingectomy is offered to women who have tubal ectopics unless they have other RFs for infertility like contralateral tube damage in which case they do salpingotomy.
31
Haemophilia, previous right-sided haemarthrosis, swollen knee, 14y/o female. Dx?
Turner’s. Haemophilia is an X-linked recessive disorder and would only be expected in males. But as patients with Turner’s have only one X, they may develop X-linked recessive conditions
32
Part of fallopian tube most associated with risk of rupture?
Isthmus
33
Define pre-eclampsia
After 20 weeks gestation Pregnancy induced HTN Proteinuria
34
What is used to prevent seizures in patient s with pre-eclampsia and treat seizures once they develop?
MgSO4. Monitor RESP RATE AND REFLEXES with this treatment. If respiratory depression occurs, need calcium gluconate
35
Causes of bleeding in the first trimester
Miscarriage Ectopic Implantation bleeding Cervical ectropion Vaginitis Polyps
36
Common intolerance after viral gastroenteritis
Lactose
37
Correct position for cord prolapse
On all fours, knees and elbows
38
First investigation for pyloric stenosis
Abdominal US
39
Child with cough and weeks presents to ED on background of viral illness. Dx and Rx?
Bronchiolitis. Supportive care.
40
Woman with previous Group B strep. Worried about this pregnancy now. Do we give abx?
Maternal IV abx prophylaxis should be offered to women with previous babies with GBS
41
What is Ebstein’s anomaly?
Causes by use of lithium in pregnancy. Causes pansystolic and middiastolic murmur. Enlargement of the right atrium
42
Levonorgestrel is taken within how long of UPSI?
72 Hours
43
Neonate. Respiratory distress and tinkling sounds heard on auscultation of precordium. Dx and rx?
Diaphragmatic hernia - gut has penetrated through hence tinkling sounds in chest. Manage with NG tube to keep the air out of the gut so INTUBATE AND VENTILATE. Definitive rx is surgical repair of hernia
44
Features of acute epiglottitis
Acute onset, relatively normal respiratory try rate, forward lean, stridor. Contact on call paediatrician, arrange same day review and admission to hospital
45
Scale used for postpartum mental health problems?
Edinburgh postnatal depression scale. Baby blues go within 3 days so anything beyond is likely postnatal depression
46
Causes of hypothyroidism
Hashimoto’s Iodine deficiency Lithium de Quervain’s thyroiditis Postpartum thyroiditis
47
What is postpartum thyroiditis?
Autoimmune condition which presents as body transitions back from immunosuppressed state of pregnancy to normal immunity. First they get thyrotoxic phase (hyperthyroid) which is treated with propranolol. Then hypothyroid phase treated with levothyrox
48
Congenital heart diseases: cyanotic vs acyanotic?
Cyanotic ToF TGA Acyanotic VSD ASD PDA Coarctation of aorta
49
Infantile colic?
Infants less than 3 months: bouts of excessive crying, pulling up of legs, often worse in evening. Reassure and support. Intussuception is 3m- 3 years and would have diarrhoea and vomiting
50
First line for vaginal candiadasis (thrush)?
Oral fluconazole. Intravaginal pessary for those who can’t have PO with unsafe swallow
51
Differentiate CAH and androgen insensitivity syndrome
Androgen insensitivity - genetically XY but phenotypically female due to reduced/absent TST receptors in target tissue. X-linked. Masses in adnexa due to undescended testes. CAH - excess androgen production causing precocious puberty and early onset of pubic hair. Females have ambiguous genitalia and vitalisation but males have normal genitalia at birth.
52
Threadworm rx?
Single dose of mebendazole for entire household and hygiene advice
53
Harsh cough in infant. DDx?
Cough in bouts that turns them red and vomiting - pertussis Bronchiolitis - wheeze Fever and chest pain - TB, pneumonia
54
Eclampsia post natal treatment
MgSO4 should continue for 24 hours after delivery or after last seizure
55
Limping child under 3?
Bloods to rule out septic arthritis XR to rule out fracture Always have specialist referral under 3 to rule out septic arthritis
56
Sheehan’s?
Reduced function of the pituitary gland due to ischaemic necrosis due to hypovolaemic shock when giving birth to their child. Therefore amenorrhoea, problems with milk production and hypothyroidism
57
Infantile colic vs infantile spasms?
In infantile spasms the child gets distressed between spasms. In colic the child becomes distressed during the spasms. Do an EEG
58
Henoch Schonlein purpura distribution?
Buttocks, extensor surfaces, arms and legs.
59
Investigation of choice in adenomyosis (presence of endometrial tissue in myometrium)?
MRI pelvis
60
Reduced foetal movements past 28 weeks. What to do?
Handheld Doppler. If no foetal heartbeat detected then immediate USS
61
How many days does a patient wait to resume hormonal contraception after ulipristal emergency contraception?
5 days
62
POI FSH/LH?
High FSH and LH
63
DVT or PE in pregnancy. Inv and Rx?
Suspected DVT - duplex USS Suspected PE - duplex USS. If confirmed no further treatment. Otherwise do VQ next. If PE is suspected, then even before VQ give LMWH. Note DOACs, warfarin and thrombolysis are all CId in pregnancy
64
Heel prick test for?
CF, congenital hypothyroidism, sickle cell disease. If immunoreactige trypsingen is raised then may indicate CF. so then we do wear test
65
Pericarditis ECG finding besides saddle-shaped ST elevation?
PR depression
66
Investigation of choice for ?aortic dissection
CT CAP
67
Child presents with round rash with pale pink Centre. Preceding symptoms are cough and sore throat. Now become lethargic and developed aches and pains. Dx?
Rheumatic fever due to Group A strep. Treat with Penicillin V Rheumatic fever: sore throat, rash, arthritis, murmur.
68
Secondary prevention of ACS meds?
ACEi, beta-blocker, statin, aspirin, ticagrelor
69
Investigations for acute angle closure glaucoma?
Gonioscopy and tonometry
70
Hypercalcaemia presentation?
Bones, stones, moans, psychiatric overtones. Might be prone to renal calculi. Low mood. Abdo pain, chnage in bowel habit. You’re less of a cutie (QT) when you’re grumpy so shortened QT interval. Hypokalaemia is prolonged QT (I’m 0-K with that tall QT). 0 K as in no potassium and tall QT as in prolonged QT
71
Suspected aortic dissection. Can’t do CT angiogram of chest, abdo and pelvis as pt clinically unstable. Next?
TOE note patients with Ehlers Danlos often get aortic dissection so hyper motility of joints, translucent looking skin, colon perforation are all signs the dissection is secondary to Ehlers
72
In angina do not use a beta blocker with…?
Verapamil - risk of complete heart block
73
First line angina
CCB or beta blocker If CCB - verapamil or diltiazem If CCB needed in combo with a beta blocker, then use use amlodipine instead of verap or diltiaz with the beta blocker Do not prescribe verapamil with a beta blocker as risk of complete heart block
74
Patient with CKD prescribed new medication. Already on statins. Develops muscle aches and dark urine. What medication?
Clarithromycin - this is an inhibitor of the P450 system and interacts with statins Leads to increased levels of atorvastatin by reduced metabolism= more likely to develop rhabdomyolysis. Risk esp high for CKD pt
75
SEs ACEi?
Cough, hyperkalaemia, angioedema
76
Causes of prolonged QTc?
TCAs SSRIs esp citalopram Haloperidol Ondansetron Hypocalcaemia, hypokalaemia, hypoMg2+
77
Suspected dry AMD. Test?
Amsler grid
78
Side effects of amiodarone
Grey skin, bradycardia
79
SVT Rx? Stable pt.
Vagal maneouevres then 6mg IV adenosine
80
Thiazides can cause which electrolyte abnormalities?
Hypokalaemia. Citalopram: QT prolongation
81
NSTEMI management?
Aspirin 300mg and fondaparinux If they’re going straight for PCI then give unfractionated heparin How to decide to go for PCI straight away? GRACE score Unstable patients go for PCI straight a way as do pts with GRACE score >3%
82
Eyelid margins sore. Dx?
Blepharitis - remove debris from eyelid margins and hit compresses
83
Pts of Afro-Caribbean origin what to give after CCB?
ARB rather than ACEi
84
ST elevation in V5 and V6 is what territory and which artery?
Lateral leads and left circumflex
85
In ALS if IV access cannot be obtained then what route should be used?
Interosseous line insertion in proximal tibia or proximal humerus Why not: IM - drug absorption too slow Rectally - absorption too slow and rectal preparations need to be made ETT - absorption through alveoli; OS better Central line - if central line already present then this can be used. If not, then intraosseous
86
Hirschprung’s investigation and Rx?
Inv: AXR and rectal biopsy Rx: rectal washouts/bowel irrigation. Definitive management is surgery to affected part of colon (anorectal pullthrough)
87
How does Meckel’s diverticulum present?
Like appendicitis but with bleeding
88
What age do febrile convulsions stop?
5 years
89
How long before upper GI endoscopy should PPIs be stopped?
2 weeks - so that the pathology can be recognised
90
Prophylaxis of cluster headaches versus migraines?
Cluster use verapamil Migraines use propanolo
91
What to do in a patient with an upper GI bleed eg oesophageal varies secondary to liver disease?
ABCDE Correct clotting: FFP, vit K, platelets Terlipressin and prophylactic abx before endoscopy Band ligation Sengstaken-Blakemore tube TIPSS Prophylaxis Propanolol Band ligation TIPSS
92
DVLA regs after first seizure clinic?
6 months
93
First unprovoked seizure but there ARE structural abnormalities/epileptiform activity on neuroimaging. DVLA?
First seizure without any abnormalities is 6 months But if there is abnormalities then 12 months
94
Pt with dysphasia and halitosis. Coughing at night. Dx?
Pharyngeal pouch. Hiatus hernia would have reflux symptoms esp after eating
95
Oesophageal candiadasis. Common exam Q causes?
HIV, steroid inhalers
96
Pt with migraines who is already on an SSRI for depression. Now has been prescribed sumatriptan. Why worry?
Serotonin syndrome Agitation, HTN, twitching muscles, dilated pupils
97
CRVO symptoms?
Sudden painless loss of vision, retinal haemorrhage. Swollen optic disc
98
After how long is the COCP effective?
After 7 days. Only if taken in first 5 days of cycle then no need for additional contraception. At any other point, need to use condoms for 7 days. POP effective after 2 days IUD effective instantly
99
Patient who had an MI then develops syncope and low BP when lying flat. ECG shows Mobitz I. How does this look and Rx?
Wenkeback - PR prolongation and then drop a QRS, regularly. Rx - pacing if symptomatic like this pt but nothing if asymptomatic
100
NSTEMI management with and without PCI availability?
Angiography not available immediately eg DGH = aspirin and fondaparinux Angiography available = unfractionated heparin (NOT LMWH) and aspirin. Unfractionated heparin preferred due to easy reversibility with protamine sulfate Use GRACE score to determine severity
101
GDM - when to start insulin immediately?
At the time of diagnosis if the glucose level is >=7 then start insulin immediately Otherwise it’s diet then metformin then your short acting insulin
102
Breeches presentation increases risk of developmental dysplasia of hip. True or false? Inv?
True. Do USS hip
103
Unilateral red eye, pain, epiphora (excessive lacrimation), photophobia, burning around eye. Fluoroscein staining shows linear, branching epithelial defect. Not a contact lens wearer. Dx, Rx?
Herpes simplex keratitis It’s a virus so topical aciclovir
104
Symptoms of dry AMD?
Progressive, subacute vision loss, loss of central vision, difficulty seeing in dark or when lights changes from light to dark. Distorted line perception on Amsler. Fundoscopy shows drusen (lipids)
105
AV nicking on fundoscopy?
Hypertensive retinopathy Arteriole crosses venule causing compression of small veins with slight bulge on either side of crossing. Not likely to have change in vision
106
Cotton wool spots on fundoscopy?
Hypertensive and diabetic retinopathy. Due to retinal arteriole obstruction causing ischaemia. No changes in vision
107
Cupping of optic disc on fundoscopy?
Glaucoma. Happens due to optic nerve damage. Glaucoma presents with blurred vision in peripheries, haloes round lights, poor vision in dark.
108
Vision loss and pain on moving eye. Dx?
Optic neuritis MS, CMV, Lyme disease, herpes
109
Causes of raised ICP?
Localised mass eg extradural, subdural, intracerebral Neoplasms like meningioma, glioma Abscess Focal oedema secondary to trauma/infarction/tumour Disturbance of CSF circulation: obstructive hydrocephalus Obstruction to major venous sinuses: cerebral venous thrombosis , depressed fractures Brain oedema: encephalitis, meningitis
110
HSP purpura how does it present?
Non-blanching rash affecting legs and buttock, arthralgia and abdo pain
111
IgA nephropathy or PSGN?
PSGN is several weeks after initial infection eg tonsillitis (Group A strep). Immune complexes like abs, complement get stuck in glomeruli—> AKI IgA nephropathy is shorter latency/same time as virus. IgA deposits in nephrons
112
Young boy, webbed neck, pulmonary stenosis, short statute. Dx
Noonan syndrome
113
Heart failure. First line is ACEi and beta. Then aldosterone antagonist like spironolactone. Then?
SGLT 2 inhibitors like dapagliflozin Then? Ivabradine and sacubatril/valsartan Digoxin Annual influenza and one-off pneumococcal
114
Management of pericarditis?
NSAIDs and colchicine
115
Scleritis associated with which two immunological conditions?
RA and SLE
116
Anterior uveitis vs scleritis?
Both: red painful eye, watering, photophobia, decreased vision Ant uveitis has small, irregular pupil, hypopyon
117
CAH presentation?
CAHnfused about genitalia
118
Whooping cough in adults present? Rx?
Clarithromycin; presents like croup in adults
119
How to define PPH? Rx?
>500ml of blood loss following delivery Causes of PPH - 4Ts Trauma Tone (uterine atony) Tissue (retained placenta) Thrombin (clotting/bleeding disorder) Rx IV oxytocin, ergometrine, carboprost (CI asthma) If medical fails then surgical intrauterine balloon tamponade
120
First line for hyperemesis gravidarum?
Promethazine and cyclizine Metoclopramide not recommended for more than 5 days due to extra pyramidal SEs
121
GORD symptoms in 6-week child?
Tummy ache, vomiting, crying, milky vomits after feeds, infants less than 8 weeks, often worse after being laid flat
122
Pt with symptoms of PE but has CKD (thus creatinine and urea out of whack). Investigation?
VQ as cannot use contrast in patient with CKD
123
Patient with BP greater than 180/120 and new signs of heart failure. Next?
Refer for acute medical admission
124
Ectopic pregnancy should be greater than how many mm for consideration of surgical management?
35mm
125
Miscarriage management versus ectopic management? Stop getting these confused
Miscarriage misoprostol Ectopic methotrexate
126
Why is dysuria a worrying symptom in pregnancy?
Indicates UTI and this is associated with premature birth/preterm labour
127
Facial lesions and burning pain on forehead. Hutchinson’s sign positive. Dx?
Herpes zoster ophthalmicus. Hutchinson’s sign is vesicles go tip of nose which is strongly associated with ocular involvement and warrants urgent Ophthalmological assessment. HZO is reactivation of herpes zoster affecting ophthalmic branch of trigeminal nerve. Rx: urgent review by ophthalm and PO antiviral

Obstetrics, Gynaecology And Paediatrics (2 decks)

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