Past Paper Knowledge Flashcards
(389 cards)
1
Q
How is eczema herpeticum characterised?
A
Rapidly worsening, painful eczema, clustered blisters and punched out lesions
2
Q
What is the first line management of eczema herpeticum in GP?
A
Immediate referral to hospital
3
Q
If injured when the elbow is flexed and pronated with pain on supination, what kind’ve MSK injury?
A
Subluxation of the radial head
4
Q
Kid from Pakistan whose parents are first cousins has acute respiratory failure and pneumocystis pneumonia, what dx?
A
SCID
Parents are consanguinous, increasing the risk
5
Q
Neonate with fever, sunken fontanelle and reduced right leg movement, most likely dx?
A
Sepsis
Reduced limb movement could indicate osteomyelitis/ osteoarthritis, or it could indicate neurological involvement due to meningitis (sepsis is the best answer)
6
Q
Which enzyme is deficient in congenital adrenal hyperplasia?
A
21-hydroxylase
This is responsible for converting 17-hydroxyprogesterone to 11-deoxycortisol (cortisol pathway), therefore build up of 17-hydroxyprogesterone is screened for
Also used to convert progesterone to 11-deoxycorticosterone (aldosterone pathway)
This increases the precursors available for testosterone formation, leading to symptoms of androgen excess
7
Q
What is the age range for reflex anoxic seizures?
A
6 months to 2 years
8
Q
When should symptoms of otitis media resolve?
A
3-7 days, if no abx seek advice if sx don’t resolve within 3 days
9
Q
When to admit for otitis media?
A
- Systemic sx
- Complications (meningitis, mastoiditis, facial nerve palsy)
- Children <3 months with temp >38 degrees
10
Q
What is the first line antibiotic for otitis media?
A
- Amoxicillin (5-7 days)
- Clarithromycin/ erythromycin (allergy)
11
Q
What is the main cause of erysipelas?
A
Group A strep
12
Q
What is the presentation of erysipelas?
A
- Very well demarcated, inflammed red region
- Usually on the lower limbs, but can present as butterfly rash on the face (cheeks and bridge of nose)
Mx: phenoxymethylpenicillin
13
Q
What are the managment options for otitis media with effusion?
A
NO ABX
- Auto-inflation (blow air out of the nose against a pressure device eg. balloon)
- Grommets + single dose of ciprofloxacin intraoperatively (+-adenoidectomy)
14
Q
What is an atypical UTI?
A
- Seriously ill
- Poor urine flow
- Abdo/ bladder masses
- Raised creatinine
- Septicaemia
- Failure to respond to tx 48hrs
- Non e.coli
15
Q
Investigations for atypical UTI in children?
A
- Urine dip MC&S
- Urinary tract ultrasound (if abnormal MCUG)
- DMSA (4-6 months after acute infection)
16
Q
When should babies younger than 6 months with a typical UTI have an USS?
A
Within 6 weeks
17
Q
What is the character of the rash in HSP?
A
Macular beginning as erythematous and becomes purpuric and raised
Backs of the legs, buttocks and arms (+ low grade fever)
18
Q
What is the management of immune thrombocytopaenic purpura?
A
Mild sx (petichial rash + no significant bleeding):
- Observation (resolves within weeks to months)
Medical:
- Corticosteroids
- IVIG
- Platelet transfusions
19
Q
What is the definitive diagnostic test for cystic fibrosis?
A
Sweat test
20
Q
When should disabling grief resolve to be classified as a normal grief reaction?
A
Within 6 months
21
Q
What is the second line drug treatment for OCD?
A
Clomipramine
22
Q
What are the symptoms of hypomagnesemia?
A
- Neuromuscular irritability
- Seizures
- Cardiac arrhythmias
23
Q
What are the symptoms of hypophosphatemia?
A
- Confusion
- Muscle weakness (including respiratory muscles leading to SOB)
- Cardiovascular symptoms
24
Q
What is the link between Alzheimer’s and down’s syndrome?
A
DS patients are more likely to develop at an earlier age and significantly increased risk of developing overall
25
Woman who got married early, presents to the GP as she is very worried about her partner going away for 2 months as she cannot make everyday decisions without him, most likely dx?
Dependent personality disorder
26
Which SSRI is advised for patients with a history of MI?
Sertraline
27
Which anti-depressant medications can cause long QT syndrome?
Certain TCAs:
- Amitripytline
- Maprotiline
SNRIs:
- Duloxetine
28
What is the first line management for drug induced akathisia?
Reduce the dose
29
When is anti-D prophylaxis required before 12 weeks?
Only if the bleeding is unusually heavy and/or is associated with abdominal pain
30
Woman after diagnostic laparoscopy had acute urinary retention which was treated and then had the catheter removed, when can she safely go home?
<20ml post void
(Need x2 200mls spontaneous voiding, bladder is 500mls)
31
When can people expect periods to return if babies are being bottle fed?
5-6 weeks after giving birth
32
How soon after birth can people get pregnant?
3 weeks, even if breastfeeding and periods haven't started
33
When should people use tampons after birth?
Not until they've had their 6 week postnatal check
34
What are the causes of echogenic bowel at 18-20 week scan?
- Incidental finding (baby swallowed some blood stained amniotic fluid)
- Cystic fibrosis
- CMV
35
What are the first line medications for hyperemesis gravidarum?
- Antihistamines: cyclizine or promethazine
- Phenothiazines: prochlorperazine or chlorpromazine
36
What are the second line medications for hyperemesis gravidarum?
- Ondansetron (small increased risk of celft palate)
- Metoclopramide (may cause EPSEs, shouldn't be used for more than 5 days)
37
Photo of white lesion on labia, painful urination. Tx?
Oral acyclovir
38
How many times a day can 50ml cyclizine be taken?
Up to 3
39
What is the function of permethrin cream?
Treatment of scabies
40
What are the IQ thresholds for learning disability?
- Mild: 50-69 (can read, write, may have jobs and live independently)
- Moderate: 35-49 (can learn basic reading, writing and functional skills, may need oversight/ supervision)
- Severe: 20-34 (unable to read/ write)
- Profound: <20 (intensive support)
41
What is a succenturiate placenta?
A condition where one or more accessory lobes develop in the placenta
Increases the risks of vasa praevia due to exposed vessels travelling across the lobes of the placenta
(other risk of vasa praevia is velamentous insertion - cord inserts directly into the membranes)
42
What does high vaginal swab detect?
- BV
- Trichomonas vaginalis
- Candida
- GBS
43
What does endocervical swab detect?
Gonorrhea
Chlamydia
44
When should fibroids be referred in primary care?
- Severe HMB/ compressive symptoms
- Fibroids >3cm or submucosal
- Fertility/ obstetric issues
- Rapid growth of fibroids after menopause
45
What are the guidelines for proteinuria without hypertension in pregnancy >20 weeks?
- 1+ proteinuria - repeat urinalysis in one week
- 2+ proteinuria - urgent secondary care assessment (even if there is evidence of UTI)
46
What are the most useful blood tests for premature ovarian insufficiency?
1. FSH
2. LH
3. Oestradiol
4. AMH
5. TFTs
6. Prolactin
47
What are the risks of water birth vs non-water birth?
- Infection
- Cord rupture
48
What is the most likely cardiac abnormality Turner's syndrome?
1. Bicuspid aortic valve
2. Coarctation of the aorta
49
What are the two types of allergic rhinitis?
- Seasonal (caused by pollen)
- Perennial (caused by house dust mites)
50
What is the management for cellulitis near the nose or eyes?
Co-amoxiclav oral or IV (depending on severity)
51
What's the most likely congenital heart condition a neonate born to a mother with SLE may have?
Congenital heart block
52
What is the time difference between early and late onset neonatal sepsis?
- EOS <72 hours of life
- LOS >72 hours of life
53
What is the first line drug for a young person with T2DM?
Metformin
54
Girl (pre-pubertal) with offensive vaginal discharge. What is the most common cause of this?
Vulvovaginitis (most common cause of offensive discharge in pre-pubertal girls)
55
40-year-old doctor with central chest pain but no abnormalities on ECG. Which drug is likely to be causing this?
Cocaine
56
What is the risk of permanent paralysis from epidural anaesthesia?
1:100000-1:200000
57
What is the first line dopamine agonist to suppress breastmilk after stillbirth?
Cabergoline
58
Which women should not recieve dopamine agonists?
Women with htn or pre-eclampsia
59
Which strains of HPV are targeted by the quadrivalent vaccine?
6, 11, 16, 18
6, 11 cause genital warts
60
What vaccines are recommended during pregnancy?
- Flu
- Whooping cough
- COVID
61
How long does erythema toxicum last?
Most cases are resolved within 2 weeks
62
What is the management of DKA?
- A-E
- Fluid bolus (10ml/kg over 60 mins without shock, over 5-10 mins if in shock)
- 1-2 hours of fluids, give insulin (0.05-0.1u/kg/hr)
- Treat hypokalaemia
63
Which observations should be taken hourly in DKA?
- Capillary blood gas
- Blood glucose
- BP
- HR
- RR
- Temp
- Level of consciousness
- Ketones
64
Which observations should be taken half-hourly DKA?
Neuro observations
65
When should febrile seizures be admitted to hospital for paediatric assessment?
- First presentation of febrile seizure
- <18 months old
- Diagnostic uncertainty
- Features of complex febrile seizure
- Focal neurological deficit
- Decreased level of consciousness before the seizure
- Child recently taken abx
- Parental anxiety
66
When is buccal midazolam given for febile convulsions?
Under specialist guidance
67
What is androgen insensitivity syndrome?
Individual is phenotypically XY but resistant to the male androgens (phenotypically female)
68
Can treatment be given under section 2 of the mental health act?
Yes, patient's don't have the right to refuse treatment except ECT
69
What are the investigations of choice for pregnant woman presenting with signs of acute PE?
- ECG
- Chest x-ray
If chest x-ray is abnormal and there is clinical suspicion of PE, CTPA >VQ scan
70
What are the next investigations for pregnant woman suspected of PE with duplex USS confirming presence of DVT?
No further investigations required
71
What are the risks of CTPA vs VQ scan in pregnancy?
CTPA increased risk of childhood cancer but lower risk of maternal breast cancer
72
Which type of ovarian cancer typically affects young women under the age of 20?
Germ cell tumours eg. dysgerminoma
73
What's required for a diagnosis of PCOS in adolescents?
- Hyperandrogenism
- Irregular menstrual cycles
74
COCP increases and decreases risks of which cancers?
Increases risk of breast and cervical (breast>cervical)
Decreases risk of ovarian and endometrial
75
What increases the risk of endometrial cancer?
- Obesity
- Tamoxifen
- PCOS
- Old age
76
What is the spectrum of placenta accreta?
- Accreta: breaches the endometrium
- Increta: breaches the myometrium
- Percreta: invades through the myometrium to the serosa
77
Which is more effective, ulipristal acetate or levonorgestrel?
Ulipristal acetate
78
Which statement about contraception is true?
- Both levonorgestrel and ulipristal can be used more than once in the same cycle as emergency contraception
- The Mirena® Coil - levonorgestrel 20 mcg/24 hrs is effective for at least 10 years
- The progesterone injection is not associated with weight gain
- The contraceptive implant is contraindicated 4wks after delivery
- Migraine with aura is UKMEC 3 for starting a patient on the combined oral contraceptive pill
Both levonorgestrel and ulipristal can be used more than once in the same cycle as emergency contraception
79
How long after a) levonogestrel and b) ulipristal acetate before starting hormonal contraception?
a) immediately
b) after 5 days - HOWEVER can be started immediately if taking COCP regularly and using UA for missed contraception in the first week (but must use condoms for 7 days)
80
What are the screening results a) triple and b) quadruple for Down's syndrome?
a) Increased HCG, decreased PAPP-A, >6mm nuchal translucency
b) Decreased AFP, decreased unconjugated oestriol, increased HCG, increased inhibin A
81
What are the results of the quadruple test for Edward's syndrome?
Decreased AFP, unconjugated oestriol, HCG and normal inhibin A
82
What are the results of the quadruple test for Neural tube defects?
Increased AFP
Normal unconjugated oestriol, HCG and inhibin A
83
What are the diagnostic criteria for T2DM?
Symptomatic:
- Single abnormal HbA1c or fasting plasma glucose
Asymptomatic
- Abormal HbA1c or fasting plasma glucose
- Abnormal result on a repeat test (preferably the same test)
84
"Cupping, splaying, bowing' are radiological findings in which condition
Osteoarthritis
Reactive arthritis
Septic arthritis
Rickets
Rickets
85
What does the delta F508 deletion mutation cause?
CFTR protein to misfold
86
What is the mechanism of Lumacaftor and Ivacaftor?
Lumacaftor (THE CORRECTOR): increases the trafficking of CFTR proteins to the CSM
Ivacaftor (THE POTENTIATOR): enables the opening of otherwise dysfunctional chloride channels
87
What is Rigler sign on x-ray?
Free air inside and outside the bowel wall, indicating pneumoperitoneum suggesting bowel perforation
88
What is a sail sign x-ray?
Suggests a fracture of one or more bones in the elbow
89
What is the first line pharmacological management for delirium?
Haloperidol (low dose)
90
In which conditions is haloperidol use contraindicated?
- Parkinson's disease
- Dementia with Lewy bodies
91
What is the role of the occupational therapy team in ASD?
Mainly for sensory stimulation
Help with routine
Focus on self-care, feeding and sleep problems
92
When is an urgent referral to a secondary mental health team indicated for postnatal depression?
- Severly depressed and considerable or immediate risk to herself/ baby
- Evidence of self neglect/ not looking after the baby
- BPAD
- History of severe mental illness (PND, PPS, BPAD)
93
Which psychtropic medications are contraindicated in breastfeeding?
- Carbamazepine
- Clozapine
- Lithium
94
Which antidepressants are the safest to take while breastfeeding?
- Sertraline
- Paroxetine
95
Which antipsychotic is the safest to take while breastfeeding?
Olanzapine
96
What is the risk of recurrence of post partum mania/ psychosis in future pregnancies?
1/2
97
Where do first generation antipsychotics act?
Block dopamine-2 receptors in the brain
98
How many weeks on antipsychotics before schizophrenia is deemed treatment resistant?
12 weeks after first episode of psychosis
>=6 weeks on two atypical antipsychotics
99
What is atypical anorexia nervosa?
Disorders that fulfil some of the features of anorexia nervosa but in which the overall clinical picture does not justify that diagnosis. For instance, one of the key symptoms, such as amenorrhoea or marked dread of being fat, may be absent in the presence of marked weight loss and weight-reducing behaviour.
100
What are the ICD10 criteria for anorexia nervosa?
- Deliberate weight loss
- Fear of fatness
- Endocrine and metabolic changes (amenorrhea)
101
What is the first line investigation for a) witnessing swallowing a coin b) not witnessing swallowing a coin?
a) metal detector --> inconclusive/ above xiphisternum AP CXR
b) urgent chest x-ray
102
What is the management of ingested button battery?
file:///C:/Users/Huawei/Downloads/425_Ingested_Foreign_Bodies%20(1).pdf
103
When is termination of pregnancy legal at any time?
- If there's a fetal anomaly that will inevitably result in the death of the foetus
- Risk of serious harm to the woman
104
A 14 year old girl has had crampy abdominal pain and poor appetite for 24
hours. She has also had a sore throat for 3 days.
Her temperature is 38.5°C. There is cervical lymphadenopathy and
tenderness in the right iliac fossa.
A. Acute appendicitis
B. Crohn's ileitis
C. Meckel's diverticulum
D. Mesenteric adenitis
E. Ovarian cyst
D. Mesenteric adenitis
Differentiating from acute appendicitis:
- More severe pain
- Rebound tenderness
- Migration of the pain from periumbilical region to right iliac fossa
105
When is referral to urogynae required for POP?
- 3rd degree prolapse
- Severe urinary bowel incontinence
- Failed PFEs when management may include more invasive options eg. surgical repair
106
When should a child be able to sit unsupported?
7 months
107
When should a child be able to speak at least 2 words?
12 months
108
When should a child be able to feed themselves using their fingers?
12 months
109
How is development in premature children adjusted?
By the number of weeks they were premature eg. born at 30 weeks, development can be delayed by 10 weeks
110
Can a diganosis of missed abortion be made without a TVUSS?
No
111
How is avoidant personality disorder characterised?
- Social inhibition
- Feelings of inadequacy
- Hypersensitivity to criticism
- Strong desire for affection and acceptance
People often avoid social situations and have few close relationships, often rely on single attachment figure
DIFFERENT FROM DEPENDENT:
- Rely on others to make decisions for them
- Transfer responsibility to others
112
What is the first line treatment for children and adolescents with anorexia nervosa?
Family therapy
Aims to improve communication and functioning
113
What is the age range for toddler's diarrhea?
6 months to 5 years
114
Who is soya milk not recommended for?
Infants under 6 months
Can interfere with absorption of nutrients and cause allergic reactions
115
What is the treatment for confusion with hepatic encephalopathy?
Lactulose
116
Are membrane sweeps an induction of labour agent?
NO
117
What is aloprostadil?
Prostaglandin E1 analogue
118
Which age group is doxycycline contraindicated in?
Under 12
Tooth discolouration
119
What are the risk factors for puerperal psychosis?
- Personal/ family history of mental illness
- Difficult/ traumatic childbirth
- Lack of social support
120
List the most common causes of infertility
- 30% male factor
- 20% ovulation failure
- 20% unexplained
- 15% tubal damage
- 15% other causes (e.g. smoking / alcohol)
121
What is the cause of ovulation pain?
Rupture of the follicle during ovulation
122
What is the most common drug-induced movement disorder?
Drug induced parkinsonism
123
What is the management for drug induced Parkinsonism?
Procyclidine
124
Where does the rash in scarlet fever start?
On the trunk and spreads to the extremities
125
Which blood test is necessary to diagnose conjugated jaundice?
Split bilirubin
126
How does SUFE typically present?
Acute onset of pain and a limp
127
What are the examination findings of Perthes?
- Reduced ROM
- Pain on internal rotation and abduction
128
Which tests are important for obstetric cholestasis?
- LFTs (degree of hepatic dysfunction)
- Serum bile acids (confirm the diagnosis)
129
What is the most common cause of post menopausal bleeding?
Atrophic vaginitis
130
Which EPSE is not improved by antimuscarinic drugs?
Tardive dyskinesia
131
What is the management for acute dystonia?
Antimuscarinic drugs eg. procyclidine hydrochloride
If life-threatening IV diazepam can be used
132
What can be used to improve the symptoms of tics and other Tourette syndrome related choreas?
Haloperidol
133
What does brainstem evoked response test?
Electrical activity in the auditory pathway in response to sound (can detect hearing loss in newborns)
134
How does the sleep pattern change with age?
Common for older adults to experience more fragmented sleep and more frequent awakenings during the night
135
What is the best investigation for restoration of liver function in a patient who has taken paracetamol overdose?
PT
136
What is co-cyprindiol?
A form of the OCP wtih anti-androgenic effects licensed for acne and PCOS
(Contraindicated in DVT)
137
What is the first step if someone sustains needle stick injury from IVDU?
Encourage bleeding from the wound (do not suck)
138
What does colonisation of urinary catheter with a mixed growth of bacteria in the absence of fever indicate?
Not an infection, no need to remove the catheter and not an indication for antibiotics
139
A 79 year old woman has been repeatedly found wandering at night by her
neighbours. The problem has progressively worsened over 6 months. She is
independent in her activities of daily living, although her family do her
shopping. She was previously well.
What aspect of cognition is likely to show the greatest impairment?
A. Attention
B. Concentration
C. Praxis
D. Registration of information
E. Short-term memory
E. Short term memory
The scenario describes a patient with symptoms
of dementia, and impairment of short-term memory is a characteristic feature of
dementia. The patient’s wandering behaviour may be due to disorientation caused
by forgetfulness or confusion. Attention, concentration, and praxis may also be
affected in dementia, but short-term memory is often the most severely impaired.
140
A 52 year old woman reports increased urinary frequency, urgency and urge
incontinence. She has multiple sclerosis, which affects her walking. A
midstream urine sample shows no cells and is sterile on culture. A bladder
scan shows a residual volume of 300 mL. Urodynamic assessment shows
that she has a neuropathic bladder.
Which is the most appropriate management?
A. α-Adrenoceptor blocker
B. Anticholinergic drug
C. Indwelling urethral catheter
D. Intermittent self catheterisation
E. Suprapubic catheter
D. Intermittent self catheterisation
MS, therefore drugs unlikely to be beneficial
141
What are the absolute contraindications for suprapubic catheter?
Absence of an easily palpable or USS localised distended bladder
142
What are the relative contraindications for suprapubic catheter?
- Bladder cancer
- Anticoagulant/ antiplatelet treatment
- Abdominal wall sepsis
- Subcutaneous vascular graft in the suprapubic region
- Uncontrolled blood clotting causing prolonged/ excessive bleeding
- Pelvic cancer
- Previous abdominal or pelvic surgery
143
How long can a suprapubic catheter be used for?
Up to 12 weeks
144
Who are suprapubic catheters indicated for?
- Spinal cord injuries
- MS
- Traumatic injury to the lower urinary tract
- Urethral strictures
145
Where are the adhesions in Fitz-Hugh-Curtis syndrome?
Between the liver and anterior abdominal wall/ diaphragm
146
How can lymphogranuloma venereum lead to tenesmus?
This can cause proctitis, leading to bloody anal discharge or tenesmus.
147
What heart condition can tertiary syphilis cause?
Aortitis
Presents with pain in the chest, back or abdomen, fever and fatigue
148
What is the management for acute migraines that are not resolved by analgesia alone?
Sumatriptan
149
What can be used as preventative treatment for migraines?
Propranolol
If symptoms are having a significant impact on QoL or if acute treatments are contraindicated/ ineffective
Amitriptyline also
150
Which medication is used to manage trigeminal neuralgia?
Carbamazepine
151
How can meningitis lead to hearing loss?
Inflammation of the vestibulocochlear nerve or damage to the hair cells of the cochlea
All children and young people should have a hearing test and paeds review 4-6 weeks after discharge
152
How is drooling in cerebral palsy managed?
Anti-muscarinic drugs like glycopyrronium bromide
2nd line: botulinum toxin injections
153
What is used in cerebral palsy to manage spasticity?
GABA agonists like Baclofen
154
Which drug class is not recommended for management of PTSD in <18 years old?
SNRIs
SSRIs
No drug treatment offered for children with PTSD
155
What is the triad of normal pressure hydrocephalus?
Wild, wet and wobbly
Dementia, urinary incontinence, gait disturbance
Managed by ventriculoperitoneal shunting
156
Which antibiotics can be used to manage tonsillitis in pregnancy with a pencillin allergy?
Erythromycin
157
6yo girl showing sx of precocious puberty. Bone tests show bones are apt for her age/bones are
6 years old (something like that). What is the dx?
Benign isolated precocious puberty
158
How does bone age relate to precocious puberty?
Significantly advanced bone age indicates either central or precocious puberty
(Hormones driving puberty accelerate bone maturation)
159
Who should risperidone not be used for more than 6 weeks in?
People with persistent aggression in Alzheimer's dementia
160
When should treatment with antipsychotics be reassessed?
After 6 weeks
161
What is the management for menorrhagia?
1. LNG-IUS
2. Consider non hormonal (TXA, NSAIDs) or hormonal (COCP, progestogens)
162
Woman has an intrauterine device/system put in. How often does she have to check for the
strings?
After menstruation
163
What is the chance of developing T2DM after gestational diabetes?
50%
164
When should individuals treated for CIN1, 2 or 3 have a repeat smear?
6 months after treatment
165
Child being exclusively fed bottle feed at 2 months. Starts crying during AND after feeds, arches
back. Dx?
GORD
166
Which antidepressants can cause gyanecomastia?
- TCAs eg. amitriptyline
- SSRIs eg. fluoxetine, sertraline, paroxetine
- MAOIs eg. phenelzine
167
How many hours after catheter removal for hysterectomy/ c-section should urine be spontaneously passed?
4 hours
Not passing within 6 hours indicates urinary retention
168
In which miscarriages should mifepristone not be offered?
Incomplete
169
What's the difference between depersonalisation and derealisation?
Depersonalisation is where you have the feeling of being outside yourself and observing your actions, feelings or thoughts from a distance. Derealisation is where you feel the world is unreal. People and things around you may seem "lifeless" or "foggy".
170
What is a triple swab?
- A NAAT swab (vulvovaginal)
- A high vaginal swab
- An endocervical swab
171
What is a NAAT swab for?
Chlamydia and gonorrhea
172
What is an endocervical swab for?
Usually only perfomed when gonorrhea has been detected on NAAT
173
How is the percentage estimated foetal weight calculated for twins?
(Larger twin - smaller twin)/ larger twin
x 100
174
When should twin pregnancies with twin to twin transfusion syndrome be delivered?
Between 34 and 36 weeks
175
What is the lambda sign?
Suggests dichoriotic diamniotic twins
176
What is the management of cervix <25mm in people with a twin or triplet pregnancy?
200mg vaginal progesterone once a day until 34 weeks
177
Continuing the pregnancy past how many weeks with DCDA twins increases the risk of fetal death?
37+6
(IOL at 37 weeks)
178
Continuing the pregnancy past how many weeks with MCMA twins increases the risk of fetal death?
36+6
(IOL by 36)
179
What are the indications for vaginal birth in twin pregnancy?
* the pregnancy remains uncomplicated and has progressed beyond 32 weeks
* there are no obstetric contraindications to labour
* the first baby is in a cephalic (head-first) presentation
* there is no significant size discordance between the twins.
180
What fraction of women who have twins via vaginal birth will have to go to c section?
1/3
181
Should twin/ triplet pregnancies be offered physiological management of the 3rd stage?
No
182
What are the indications for episiotomy?
- Fetal distress
- Instrumental delivery
- Imminent perineal tear
- Delayed second stage of labour
183
When should episiotomy be performed?
At a 60 degree mediolateral angle when the baby's head is crowning
184
What is the link between episiotomy and instrumental delivery?
Nulliparous women:
- All foreceps and ventouse deliveries should use episiotomy
Multiparous women:
- All foreceps
- May be omitted in ventouse
185
What examination should be performed after episiotomy?
Thorough examination of the perineum and rectum after every episiotomy
186
How long does an episiotomy take to heal?
2-3 weeks
187
Is an episiotomy a contraindication for a future vaginal birth?
No
188
What is the monitoring timeframe for CIN1?
Cervical screening 1 year after colposcopy
- HPV -ve invited for cervical screening in 3 years (regardless of age)
189
What is the monitoring for CIN2?
Repeat colposcopy and biopsy 6 months after original colposcopy (if LLETZ isn't recommended)
- If CIN has stayed the same, repeat colposcopy in 6 months
- If CIN has progressed, treatment
- If CIN has stayed the same for 2 years, treatment
190
What is the difference between a total and radical hysterectomy?
Total:
- Body of uterus and cervix removed
Subtotal:
- Uterus only removed (cervical screening needed)
Radical:
- Uterus, cervix, fallopian tubes and ovaries removed
Hysterectomy and bilateral salpingo-oophorectomy:
- Same as above, but cervix not removed
191
How long after LLETZ is smear test performed?
6 months
192
What is the management of PID with IUD in situ?
- Can remain in situ if clinically improving 48-72 hours after abx and non-severe sx at presentation
- Severe symptoms at presentation, IUD removed
193
What are the follow up guidelines for PID?
- Apt 72 hours to see how abx are working
- Repeat gonorrhea testing at 2-4 weeks after treatment completed
- Repeat chlamydia testing 3-5 weeks after treatment completed
194
How effective is tubal occlusion vs vasectomy?
Tubal occlusion failure 0.05% (99.5%)
Vasectomy failure 0.05% (99.95%)
195
How long after laparoscopic sterilisation should hormonal contraception be continued?
7 days
(if scheduled during hormone free interval, hormone free interval should be omitted)
196
How long after hysteroscopic sterilisation should contraception be used?
Until tubal occlusion is confirmed by X-ray, USS or hysterosalpingogram at least 3 months after the procedure
197
How long before sterilisation should people not have unprotected sex?
At least one month
Condoms count as protection, OCP must not be stopped before operation
198
Woman with continuous vaginal dribbling?
Vesicovaginal fistula
199
Which extra tests would a smoker require during pregnancy?
Serial growth scans
200
Do vaginal tears affect subsequent modes of birth?
No, maternal choice
201
What is the management for vaginal candiasis?
1. Oral fluconazole
2. Clotrimazole 500mg pessary (first line in pregnancy)
202
By how much does sodium valproate increase the risks of neural tube defects?
1-2%
203
Woman who has had a c-section gets a headache 24 hours after delivery?
Post-dural headache
204
What is the best test to predict pre-term labour?
Cervical length
205
What is Wernicke's triad?
- Altered mental state
- Ataxic gait
- Ophthalmoplegia
206
What are the chances of developing schizophrenia if various family members are affected?
- Identical twin 50%
- One parent 10%
- Sibling 10%
207
Which EPSE is torticollis indicitive of?
Acute dystonia
Procyclidine hydrochloride management
208
What does an AMTS score of <=6 suggest?
Dementia or delirium
209
What is the threshold for postpartum psychosis?
Within 6 weeks of delivery
Symptoms usually start within 2 weeks of delivery
210
What is the name of the surgery for testicular torsion?
Scrotal exploration and bilateral fixation
211
What is the procedure when a child is sexually active <13?
Referral made to children's social care and a full assessment undertaken in partnership with the police
212
What does a low normal specific gravity urine mean?
Urine is diluted
213
Where is the lesion in ataxic CP?
Cerebellum
214
How should influenza vaccine be given to a child with an egg allergy?
GP surgery/ schools (small amount of egg protein in flu vaccines)
215
When is otoacoustic emission testing performed?
Newborn
A computer-generated click is played through a small earpiece. The presence of a soft echo indicates a healthy cochlea
216
When is auditory brainstem response testing performed?
May be done if otoacoustic emission test is abnormal
217
When is distraction testing performed?
6-9 months (actual age or developmental age)
Sounds are produced either side of the child out of their field of view
218
When is recognition of familiar objects testing performed?
18months - 2.5years
Take familiar objects and ask the child 'where is the teddy'
219
Which hearing tests are performed >2.5 years?
- Performance testing
- Speech discrimination tests
220
When is pure tone audiometry performed?
>3 years
The child listens for different tones through headphones. Each time they hear a tone they put a peg in a pegboard: older children and teenagers are given a button to press.
221
What is the Westley Croup score?
- Chest wall retractions: 0-3 (none, mild, moderate, severe)
- Stridor: 0-2 (none, with agitation, at rest)
- Cyanosis: 0, 4, 5 (none, with agitation, at rest)
- Air entry: 0-2 (normal, decreased, markedly decreased)
<= 2 mild
2-7 moderate
8-11 severe (hospitalisation)
>= 12 life threatening (PICU)
222
What are the reasons for delaying cervical smear?
- Is menstruating
- Is less than 12 weeks post-partum
- Is less than 12 weeks after a termination of pregnancy, or miscarriage
- Is pregnant
- Has a vaginal discharge or pelvic infection — treat the infection and take the sample on another occasion
223
You are asked to assess a 5 year-old girl on the ward with new onset central abdominal pain. Who would you first like to talk to in order to establish the history?
a. Her mother
b. Her nurse
c. The ward sister
d. The girl
e. The girl herself and her mother
The girl herself and her mother
224
A two-year-old boy is seen in Paediatric Out-Patients because of parental concerns about his nutritional status and growth. The best way to assess these concerns would be to:
a. Assess his weight for height
b. Calculate his Body Mass Index (BMI)
c. Measure his height & weight in clinic
d. Measure his mid-upper arm circumference
e. Review and plot serial weights and heights
Review and plot serial weights and heights
225
A previously healthy 2-year-old child presents with a 24 hour history of diarrhoea and vomiting. Which of the following is the single, most accurate method for assessing the degree of dehydration?
a. Assess skin turgor
b. Assess the fontanelle
c. Calculate the difference between the current weight and the predicted weight from the child’s growth records
d. Examine the mucous membranes
e. Measure the heart rate and blood pressure
Calculate the difference between the current weight and the predicted weight from the child’s growth records
226
4) A 3-year-old boy attends the Paediatric A+E Department because he has developed an itchy rash whilst at a birthday party. Of the following features, which requires immediate treatment with 0.01 ml/kg of 1:1000 adrenaline i.m.?
a. Blood pressure of 88/50
b. Generalised urticaria
c. Lip swelling
d. Respiratory rate of 22/minute
e. Wheeze on auscultation
Wheeze on auscultation
A. is within the normal blood pressure range for a 3 year old (85-110/42-70)
227
A twelve year old boy has had seven episodes of spontaneous lip swelling and bilateral periorbital oedema in the last three years. His father also had similar episodes in childhood. What is the most likely immunological mediator?
a. C1 esterase inhibitor
b. Complement C4
c. Eosinophils
d. Histamine
e. IgE antibodies
A. C1 esterase inhibitor
This is hereditary angioedema (suggested by spontaneous and family hx) caused by a deficiency in the c1 esterase inhibitor leading to excessive complement activation and bradykinin formation
Bradykinin is a vasodilator causing oedema
228
An eight year old boy presents with nocturnal cough and early morning tiredness. He has a past history of serous otitis media. On examination, he has noisy breathing, is overweight and is inattentive during consultation. What is the most likely diagnosis?
a. Asthma
b. Chronic bronchitis
c. Obstructive sleep apnoea
d. Pertussis
e. Pulmonary tuberculosis
Obstructive sleep apnoea
Children with OSA often exhibit daytime sleepiness, behavioral issues, and problems with attention and concentration due to sleep fragmentation.
While not directly related to OSA, a history of serous otitis media can indicate potential upper airway issues, such as enlarged adenoids or tonsils, which are common causes of OSA in children
229
What is the x-ray finding of bacterial pneumonia in a neonate?
Reticulonodular shadowing
230
An 18 month old boy is seen with a history of recurrent oral candidiasis. He developed tetany in the newborn period and had cardiac surgery for a complex heart defect. What is the most likely immunological deficiency?
a. B-cells
b. Complement C3
c. Neutrophils
d. NK cells
e. T-cells
T cells
DiGeorge syndrome
C- cardiac defects
A- abnormal facies
T- thymic aplasia
C- cleft palate
H- hypocalcaemia
22- 22q11 deletion
231
Where does the rash in chickenpox start?
On the face, scalp or trunk
232
Where does the measles rash start?
On the face and spreads downwards
233
What is the characteristic pattern of roseola?
Fever that resolves and is followed by maculopapular rash starting on the trunk and spreading to the limbs and neck
234
Where does the rash in rubella start?
On the face and spreads downwards, fine macular rash
235
Which blood test is a key diagnostic marker for post-streptococcal glomerulonephritis?
Low C3 and (occasionally) C4 levels
236
A 15-month-old girl is not meeting her gross motor developmental milestones and is generally very irritable. She was growing on the 50th centile, but is now on the 25th. She has 2-hourly breast feeds and consumes minimal solids with no additional dairy products. Her mother is wearing clothing that envelops her whole body.
What is the most likely diagnosis?
a. Failure to thrive
b. Iron Deficiency
c. Nutritional Rickets
d. Phosphate deficiency
e. Vitamin A deficiency
Nutritional rickets
Breast milk is deficient in vitamin D, iodine, iron and vitamin K. Mother wearing clothing that envelops whole body = limited sun exposure.
Failure to meet gross motor milestones indicates a skeletal issue.
237
A 7-month-old girl adopted from an orphanage in Nepal is below 0.4th centile for length and weight. The birth history was apparently normal, apart from prolonged jaundice postnatally. She is not yet sitting. On examination she is hypotonic and flaccid. The lower limb reflexes are hard to elicit. What is the most likely underlying condition?
a. Cerebral palsy
b. Congenital hypothyroidism
c. Down syndrome
d. Muscular dystrophy
e. Myasthenia gravis
Congenital hypothyroidism
238
A three-year-old girl is brought into A+E by her parents. She is usually fit and well. Her mum says that half an hour ago she ran into a table and banged her head on the corner. She went pale and fell to the floor, and then had two or three twitching movements before starting to cry. She is now back to her normal self and is running round A+E. Clinical examination is normal. What is the most appropriate action?
a. Organise an ECG
b. Organise an EEG
c. Organise neuro-imaging
d. Reassure the parents
e. Teach parents how to give buccal midazolam if this recurs
Reassure parents
Likely a benign convulsion with a minor head injury. The convulsions are brief, the child recovers quickly, and no specific treatment is usually required.
239
A 13-year-old boy presents to his GP for a routine physical prior to participation in competitive sports. He has had no recent illnesses and no past medical history of note. His height and weight are on the 75th centile for his age. Cardiovascular examination reveals a grade 2/6 ejection systolic murmur heard loudest at the left lower sternal border. It is low pitched and musical but does not radiate.
Which of the following is the most likely diagnosis?
a. Atrial septal defect
b. Mitral stenosis
c. Tricuspid regurgitation
d. Ventricular septal defect
e. Vibratory innocent murmur
Vibratory innocent murmur
1-2/6 indicates soft
>=3 is loud and may not be an innocent murmur
240
What are the chest x-ray findings of neonatal respiratory distress syndrome?
Bilateral, predominantly peripheral, consolidation with air bronchograms
Occasionally diffuse whiteout
241
A healthy 4-year-old girl develops acute onset of petechiae and epistaxis. Laboratory findings include haemoglobin = 12g/dL; white cell count = 5.5 with normal differential; and platelet count = 15. Of the following investigations, which would you do next?
a. Blood film
b. Bone marrow aspirate
c. Check the bleeding time
d. Clotting studies
e. Platelet antibody tests
Blood film
Shows:
- Platelet morphology and distribution
- Rules out pseudothrombocytopaenia
Step after that would be platelet antibody testing (likely ITP)
242
How long are maternal IgG antibodies present in a baby?
6 months
243
What is the meaning of bulky stool?
Fat not being absorbed and passed in the stool
244
What are the signs of congenital hypothyroidism?
- Prolonged jaundice (most common sign)
- Hypotonia
- Poor feeding
- Constipation
- Large fontanelle
- Coarse facial features
- Delayed growth and development
245
49) A 14 year old girl with known sickle cell disease presents to the A+E department with severe pain in her right leg. What should your first step be in managing her case?
a. Take a full history
b. Examine her fully
c. Ensure she has adequate analgesia
d. Start IV fluids
e. Give IV antibiotics
Ensure she has adequate analgesia
Rapid and effective pain control is always the first step for sickle cell crisis
246
What are the x-ray findings for meconium aspiration syndrome?
Lung hyperinflation and patchy infiltrates
247
Two unrelated infants are born at 36 weeks’ gestation. One infant weighs 2600g at birth and the second infant weighs 1600g. Which of the following conditions is the second baby more likely to have?
a. Congenital malformations
b. Hyperglycaemia
c. Low haematocrit
d. Occipito-frontal (head) circumference that is small compared to body weight
e. Surfactant deficiency
Congenital malformations
The infants are unrelated so this is not TTT transfusion syndrome.
1600g indicates possible IUGR which increases the risk of congenital malformations.
248
57) An eight year old girl is seen with a second episode of cervical abscess in three months. The first culture grew Klebsiella pneumoniae. On this occasion Staphylococcus aureus was cultured. What is the most likely immunological mediator?
a. B-cells
b. Complement C3
c. Macrophages
d. Neutrophils
e. NK cells
Neutrophils
249
A 3-month-old breast-fed girl presents with a 3 day history of increasing breathlessness and difficulty with feeding. On examination she is tachypnoeic and hypoxic with no crepitations or wheeze and no abnormal upper airway signs. Her mother declined antenatal blood tests.
What is the most likely underlying cause of this child’s respiratory illness?
a. Group B streptococcal infection
b. HIV infection
c. Influenza virus
d. Respiratory syncytial virus
e. Viral meningitis
HIV infection
Likely lymphocytic interstitial pneumonitis which can present with chronic respiratory symptoms (tachypnea and hypoxia) without creps or wheeze
250
An eight year old girl is seen with a second episode of cervical abscess in three months. The first culture grew Klebsiella pneumoniae. On this occasion Staphylococcus aureus was cultured. What is the most likely immunological mediator?
a. B-cells
b. Complement C3
c. Macrophages
d. Neutrophils
e. NK cells
Neutrophils
Recurrent abscess formation in response to infection is classic of neutrophil dysfunction
251
When is chemotherapy allowed for use in pregnancy?
2nd and 3rd trimesters, birth should be 2-3 weeks after the last chemo therapy to allow bone marrow regeneration
Radiotherapy contradicated unless a life-saving option
252
Which vitamin supplement is recommended for pregnant women BMI >30?
Daily vitamin D 10mg
253
What % of pregnancies in the UK are complicated by diabetes?
2-5%
254
What % of diabetes in pregnancy is gestational diabetes?
85%
255
At what gestation should steroids not be given?
<24 weeks and >35+6 (can consider steroids between 34-35+6)
256
When should delivery with PPROM be aimed for?
34-36 weeks
257
Which benign murmur is often heard in pregnancy?
Soft systolic flow murmur
Dilatation acorss the tricuspid valve causing regurgitation - physiological and will disappear after pregnancy
258
How often should liver enzymes be measured in obstetric cholestasis?
Weekly
259
What does obstetric cholestasis increase the risk of?
- Still birth
- Pre-term labour
- Meconium staining
260
What are the absolute contraindications of ECV?
- Multiple pregnancy
- Major uterine abnormality
- Antepartum haemorrhage
- Rupture of membranes
261
What are the relative contraindications for ECV?
- Small for gestational age with an abnormal Doppler scan
- Pre-eclampsia
- Scarred uterus
- Oligohydramnios
262
When can T1 diabetic mothers who have been on an insulin sliding scale during birth return to normal insulin?
Once they have started eating and drinking eg. 6 hours after the operation
263
How much does pregnancy increase the risk of an SLE flare up?
40-60&
264
What are the risks associated with SLE and pregnancy?
- Spontaneous miscarriage
- Fetal death
- Pre-eclampsia
- Preterm delivery
- Fetal growth restriction
265
What can listeriosis in pregnancy cause?
- Mid-trimester loss
- Early meconium
- Preterm labour
266
Where does pemphigoid gestationis start?
At the umbilicus
267
Where is the rash in prurigo of pregnancy/ prurigo gestationis?
Trunk and upper limbs with abdominal sparing
268
What is impetigo herpetiformis?
A blistering condition that always presents with a febile illness.
Sterile pustules and erythematous plaques
269
At how many weeks of pregnancy does blood pressure fall to its lowest?
22-24 weeks
270
What are the risks of developing T2DM for someone who has GDM?
35-60% over the next 10-15 years
271
Which children with Croup should be admitted?
Features of moderate or severe croup:
- Seal-like barking cough
- Stridor at rest
- Sternal recession at rest
- Agitation/ lethargy
- Resp rate >60
- High fever/ looking unwell
272
What is the management of Croup whilst awaiting hospital admission?
- Controlled supplementary oxygen
- Oral dexamethosone (0.15mg/kg)
- If too unwell for oral, inhaled budesonide (2mg nebulised as a single dose) or IM dexamethosone (0.6mg/kg single dose)
Second dose of dexamethosone can be given 12 hours after the first dose
273
What are the red flag signs for colour in paeds?
- Pale/ mottled/ ashen/ blue
274
What are the red flag signs for activity in paeds?
- No response to social cues
- Appears ill to a HCP
- Doesn't wake when roused/ doesn't stay awake
- Weak, high pitched or continuous cry
275
What are the red flag signs for respiratory in paeds?
- Grunting
- Tachypnoea (>60)
- Moderate or severe intercostal recession
276
What are the red flag signs for circulation and hydration in paeds?
Reduced skin turgor
277
What are the red flag signs for other in paeds?
- <3 months temperature >=38
- Non-blanching rash
- Bulging fontanelle
- Neck stiffness
- Status epilepticus
- Focal neurology
- Focal seizures
278
What is heard with ASD?
Ejection systolic murmur, fixed splitting of S2
279
Which syndrome is ostium secundum associated with?
Holt-Oram syndrome (tri-phalangeal thumbs)
280
What is the step-wise management for ADHD?
1. Education and information about ADHD and advice about parenting strategies (group sessions, but individual sessions offered if there are difficulties attending group sessions)
2. Medication (if symptoms still causing persistent and significant impairment in at least one domain after environmental modifications have been implemented)
ONLY OFFER MEDICATION IF >5
281
When is CBT offered in ADHD?
Those who have benefitted from medication but symptoms are still causing significant impairment in one domain eg:
- Social skills with peers
- Problem solving
- Self-control
- Active listening skills
- Dealing with and expressing feelings
282
When would a DRE be performed in a child <1 with idiopathic constipation?
If they don't respond to optimum treatment within 4 weeks, urgent referral to HCP competent in DRE and interpreting anatomical abnormalities/ Hirschprung's disease
283
What is the disimpaction regimen for constipation?
1. Movicol & electrolytes
2. After 2 weeks, add a stimulant laxative
3. If all oral medications have failed and the family consent, sodium citrate enema can be used
4. If sodium enema has failed, consider phosphate enema under specialist supervision
5. If all above have failed, can consider manual evacuation under anaesthesia
Review within 1 week
Can initially increase symptoms of soiling and abdominal pain
284
What is the maintenance therapy for constipation?
Started as soon as bowel is disimpacted
1. Movicol & electrolytes
2. Stimulant laxative if 1. unsuccessful
3. Substitute movicol for stimulant if movicol not tolerated and add another laxative eg. lactulose if stools are hard
Continue medication for several weeks after regular bowel habit is established
If toilet training remain on laxatives until toilet training is established
Gradually reduce dose over a period of months in response to stool consistnece and frequency
285
What is a positive Mantoux test?
>5mm, regardless of BCG vaccination
Offered for all children 2-17
286
Which initial tests for TB should be offered to immunocompromised patients?
Mantoux and IGRA
287
What is the management for latent TB?
- 3 months of isoniazid (with pyridoxine) and rifampicin OR
- 6 months of isoniazid (with pyridoxine)
288
What is the diagnostic test for TB in children <15 suspected of pulmonary TB?
Rapid diagnostic nucleic acid amplification tests
289
What is the management for active TB?
- Isoniazid (with pyridoxine), rifampicin, pyrazinamide and ethambutol for 2 months THEN
- Isoniazid (with pyridoxine) and rifampicin for a further 4 months
6 months of treatment total (4 for 2 months, 2 for 6 months)
290
What are the first investigations to order for precocious puberty?
1. Tanner staging
2. Measurement of testicular size
3. Bone age assessment
4. FSH and LH levels (pre-puberty FSH is dominant, during LH dominant), differentiates CPP from PPP
5. GnRH stimulation test (pubertal response considered with serum LH >=5 after stimulation)
6. Serum oestrogen/ testosterone
7. USS pelvis
291
What is the initial management for nephrotic syndrome in a child?
Admit to the ward
Corticosteroids
Monitor daily dipstick of first morning urine and daily weight
292
When is albumin infusion indicated for nephrotic syndrome?
Symptomatic hypovolaemia or severe diuretic resistant oedema - stop immediately if there are signs of respiratory distress
Only after discussion with consultant
293
What is the most common reason to stop using the nexplanon implant?
Changes to bleeding pattern
294
Which ligament is torted in ovarian torsion?
Infundibulopelvic ligament
295
What is the blood supply to the ovaries?
Dual blood supply from the ovarian arteries and uterine arteries
296
What is the presentation of ovarian torsion?
- Lower abdominal or pelvic pain (may be constant or intermittant - depending on whether ovary is torting/ untorting)
- Fever (if ovary is necrotic)
- Guarding, rigidity or rebound tenderness may indicate necrotic ovary
297
When is referral made for UTI in pregnancy?
- Recurrent
- Catheter associated
- Atypical
- Underlying structural cause
298
What should be done if GBS is detected in urine culture for pregnancy?
Midwife and obstetric team are made aware, will need intrapartum abx
299
What is the management for all breast abscesses?
Urgent referral to secondary care
- Confirmation of diganosis by USS
- Drainage of abscess (USS guided needle aspiration or surgical drainage)
- Culture of fluid from abscess (guides abx choice)
Meanwhile, continue breastfeeding from both breasts
If too painful, express the milk until they are able to continue breastfeeding
300
When should a breast abscess be suspected?
- Recent mastitis/ prior breast abscess
- Fever and/ or general malaise
- Painful, swollen lump in the breast with redness, heat/ swelling of the overlying skin
301
What is the management for infected nipple fissure that has not improved after 12-24 hours/ breast milk culture is positive?
- Abx organisms are sensitive to
- Flucloxacillin (10-14 days)
Seek immediate medical advice if symptoms fail to settle after 48 hours of abx treatment
302
What is the gold standard test for diagnosing precocious puberty?
GnRH stimulation test
303
Where is the lesion in spastic cerebral palsy?
Cerebral cortex/ pyramidal tracts
304
What is a 'show'?
A plug of mucus sometimes brown or spotted with blood that's released when the cervix begins to open
305
What is the minimum cm dilated for ARM?
2cm
306
How long should the foetal heart rate be monitored before IOL?
30 minutes
307
What are the risks of mechanical IOL?
- Uncomfortable
- Increased risk of needing oxytocin
- Small risk of cord prolapse
308
Which medical induction of labour treatment has the lowest risk of hyperstimulation?
Misoprostol (E1)
Rather than dinoprostol (E1)
309
Which IOL medication has the highest risk of hyperstimulation?
Dinoprostone vaginal pessary
310
What is the monitoring whist on oxytocin drip for IOL?
Continuous CTG
311
How frequently is the dose of oxytocin increased for IOL?
Every 30 minutes
312
When are the developmental screening tests?
- 6-8 weeks: physical examination
- 9-12 months: assessment of language and learning
- 24-30 months: second health development review
313
Where should a referral for gross motor delay be made?
Occupational and physical therapy
314
Where should a referral for fine motor/ vision delay be made?
Occupational therapy and sensory-motor and sensory-processing therapy
315
Where should a referral for speech and language delay be made?
Speech and language therapy
316
Where should a referral for social and emotional delay be made?
Occupational therapy/ behavioural therapy
317
Which vaccines are recommended in pregnancy?
- Flu
- Whooping cough
- COVID
Live attenuated vaccines are contraindicated, but can be considered if the benefits outweigh the risks eg. yellow fever
318
How long after c-section is heparin restarted?
4 hours
319
When are double gloves worn during c-section?
HIV positive
320
What blood sampling must be done in all emergency c-sections?
Cord pH from artery and vein
321
When is weight loss the first line intervention for stress incontinence?
If the BMI >30
322
Who should be notified if someone opts out for cervical screening?
Cervical screening call and recall
323
When should the cervical smear sample be repeated in 3 months?
If the test result is unavailable or cervical cytology is inadequate at any stage
324
What is the pathway if colposcopy is inadequate?
HPV +ve / cytology shows low grade repeat colposcopy in 12 months
HPV +ve / cytology high grade or borderline/ endocervical undertake LLETZ
325
What is the recall if colposcopy showed no CIN but HPV positive/ cytology low grade?
Recall in 36 months
326
What is the management if colposcopy showed no CIN but HPV positive and cytology high grade?
Discuss at MDT meeting within 2 months
327
When does the moro reflex disappear?
3-4 months
328
What does unilateral absence of the moro reflex suggest?
Damage to the brain or spinal cord
329
What does unilateral moro reflex suggest?
Damage to the clavicle or brachial plexus
330
When should lochia after birth stop?
By 12 weeks pp
331
Which pathogens cause puerperium sepsis?
- Step pyogenes
- E. coli
- Staph aureus
- Strep pneumoniae
- MRSA
332
Which drugs should be avoided for pain relief in puerperium sepsis?
NSAIDs
333
What is the antibiotic regimen for puerperium sepsis?
Pipericillin/ tazobactam or carbapeneum + clindamycin
334
What is a blighted ovum/ anembryonic pregnancy?
A gestational sac with no developing embryonic pole or yolk sac development
335
What is the management for anembryonic pregnancy?
Two scans 10-14 days apart to confirm
336
What is a pseudosac?
Seen in 10-20% of ectopic pregnancies, decidual sac rather than embryonic sac (no yolk sac)
337
What is the cause of the pain in ruptured ovarian cyst?
Irritation to the peritoneal lining
This will gradually decrease with analgesia and as the peritoneum absorbs the free fluid
338
What is the imaging for a pregnancy of unknown viability?
Repeat scan in 10-14 days to confirm
339
How often is the follow up for HRT?
3 months if HRT has been started/ changed and then annually
340
When can women with previous VTE without first trimester risk factors be started on antenatal prophylaxis?
28 weeks
341
What are the long term side effects of ECT?
Memory loss
342
What are the short term side effects of ECT?
- Cardiac arrhythmias
- Headaches
- Nausea
- Muscle aches
343
What should be suspected if several patients, exposed to the same evironment present with delirium?
Carbon monoxide poisoning (check pulse oximetry)
344
What is an extracampine hallucination?
A hallucination that exceeds the limits of normal sensory fields eg. hearing voices being projected from mars
345
What does Maudsley Anorexia Nervosa Treatment for Adults involve?
Speaking to a therapist to discover the root of the cause and encouraging a behavioural change to develop a non-anorexic identity
346
What does specialist supportive clinical management for AN involve?
Similar to MANTRA but more practical steps and advice
347
What is the washout period for MAOIs?
2 weeks
348
What is the triad for Wernicke's encephalopathy?
- Opthalmoplegia
- Ataxia
- Confusion
349
What are paraphilias?
Disorders of sexual preference
350
What is an overvalued idea?
A reasonable idea that is pursued beyond the bounds of reason
351
How can DBT be explained?
It focusses on validation (teaching the patient to accept who they are) and the relationship between the therapist and the patient, which is used as motivation to change unhelpful behaviours
352
What is the monitoring regimen for clozapine?
- Weekly WCC monitoring for 18 weeks
- Then WCC every 2 weeks for 1 year
- Then WCC monthly
353
What is the general monitoring for all antipsychotic drugs?
- Prolactin and fasting blood glucose at baseline, 6 months then yearly
- Blood lipids and weight at baseline, 3 months and yearly
354
How are benzodiazepine overdoses reversed?
Benzodiazepine antagonists eg. flumazenil
355
What is given in cocaine poisoning?
Diazepam (to reduce agitation)
356
How often do patients given rapid tranquilisation need to be monitored?
Every hour
357
What are the indications for prescribing medication for insomnia?
- Sleep hygiene failed
- Daytime impairment is severe causing significant distress
AND
- Insomnia likely to resolve soon, due to a short term stressor
358
Which medications should be prescribed for insomnia?
Non-benzodiazepine hypnotic medication eg. zopiclone
3-7 days
359
What is the management for insomnia if sleep hygiene fails, daytime impairment is significant and insomnia is unlikely to resolve soon?
CBT for insomnia
360
What is chronic insomnia?
>3 months
361
What is the first line management for chronic insomnia?
CBT
362
Which enzyme will be raised after bouts of purging?
Amylase
363
What is the screening tool used to assess severity in social phobia?
Social phobia inventory (SPIN)
364
What is the SADPERSONs scale used to assess?
Suicide risk
365
What is dissociative fugue?
Amnesia and purposeful travel beyond the usual everyday range
366
What is trance and possession disorder?
A dissociative disorder which causes temporary loss of personal identity with full awareness of the surroundings
367
What are the symptoms of frontal lobe syndrome?
- Executive dysfunction
- Change in social behaviour and personality
- Apathy
- Lack of insight into personality change
- Forced utilisation (using objects in an appropriate way but at an inappropriate time)
368
When is lithium added after an acute manic episode?
4 weeks after the antipsychotic
369
How is methadone usually given?
As an oral liquid
370
How is buprenorphine usually given?
Sublingual
371
What are Lewy bodies?
Alpha synuclein proteins
372
What are the non-agranulocytosis complications of clozapine?
- Myocarditis
- Cardiomyopathy
- NMS
- Impairement of intestinal peristalsis
373
What are the side effects of lithium?
L - leucocytosis
I - insipidus
T - tremor
H - hypothyroidism
I U - Increased Urine output
M - mothers (teratogenic)
374
What are the features of benzodiazepine withdrawal?
- Insomnia
- Agitation
- Anxiety
- Tremor
- Tinnitus
- Sweating
375
When can gastric lavage be considered for lithium overdose?
If it's within an hour of the overdose
376
How is Meckel's diverticulum diagnosed?
Technetium-99m scan
377
What is the first step in managing acute epiglottitis?
Transfer to ITU
Then blood cultures and IV ceftriaxone (recovery 2-3 days)
378
When is CPR started in a child?
If they've recieved 5 rescue breaths and deemed to have no signs of life (abnormal breathing, <60bpm)
379
Which ages is drug treatment for obesity not recommended?
<12
380
What is the most common cause of acute scrotum?
Hydatid torsion
(presence of cremasteric reflex and blue dot sign)
381
What is the management of premature thelarche?
Reassure the parents and follow up in 4-6 months
Only if there is isolated breast growth and no other signs of premature puberty
382
At how many months of life does TOF present?
1-2 months
If the infant is struggling to feed before this consider choanal atresia
383
What's the most common cause of stridor in an infant?
Laryngomalacia
384
What is the first line management for headlice?
Wet combing (applying conditioner to the hair and combing the hair with a detection comb)
x5 over 3 weeks
If wet combing is unsuccessful dimeticone 4% can be used
No need for school exclusion
385
What is the initial management for otitis media with effusion?
Active observation for 6-12 weeks (spontaneous resolution is common)
During this period, two hearing tests (pure tone audiometry and tympanometry)
If features persist after 3 months, referral to ENT and consider myringotomy and gromnets
386
How long after birth should the umbilical stump fall off?
1-2 weeks
387
What is the management for omphalitis?
Blood cultures and IV fluclox and gentamicin
388
When should phimosis resolve by?
2 years
389
When does breastmilk jaunice resolve by?
4-5 weeks
