Random Specialities Facts

Question 1

Uterus palpable abdominally at how many weeks

Answer 1

Uterus palpable abdominally at 12-14 weeks

Question 2

Engagement =

Answer 2

If 2/5 head palpable abdominally, then more than half has entered the pelvis and so the head
must be engaged

Question 3

What is used to date pregnancies under 14w?

Answer 3

NICE guidelines: should date women using crown rump length if <14 weeks

Question 4

Causes of raised AFP

Answer 4

Alpha fetoprotein
o Produced by fetal liver
o Open neural tube defect or abnormalities such as gastrochisis - increased maternal AFP
o Indicates risk of third trimester complications
o Seldom used as USS more accurate

Question 5

 Low PAPP-A (1st tri)
 High B-hCG (1st/2nd)
 Low AFP (1st/2nd)
 Low oestriol (2nd)
 High inhibin (2nd)

Answer 5

DOWNS

Question 6

Absence of cranium
 Frog Eye appearance on USS
 Incompatible with life

Answer 6

Anencephaly

Question 7

 Partial extrusion of abdominal contents in peritoneal sac
 50% have chromosomal problem
 Isolated, small defects have good prognosis

Answer 7

Exomphalos

Question 8

 Free loops of bowel in amniotic cavity
 Rarely associated with other abnormalities
 Common if mother young
 >90% survive – requires postnatal surgery

Answer 8

Gastroschissis

Question 9

 Dependent on systemic vascular resistance and cardiac output
 Falls to a minimum in second trimester by 30/15mmHg due to  SVR
 By term, BP is at pre-pregnant levels
 HTN due to PET is largely due to  SVR
 Protein excretion in pregnancy is increased, but in absence of underlying renal disease, should be
<0.3g/24h

Answer 9

Normal BP changes in Pregnancy

Question 10

Normal BP changes in Pregnancy

Answer 10

 Dependent on systemic vascular resistance and cardiac output
 Falls to a minimum in second trimester by 30/15mmHg due to  SVR
 By term, BP is at pre-pregnant levels
 HTN due to PET is largely due to increased SVR
 Protein excretion in pregnancy is increased, but in absence of underlying renal disease, should be
<0.3g/24h

Question 11

Simple classification of PET

Answer 11

Mild (140/90-149/99mmHg) Moderate (150/100-159/99mmHg) Severe (>160/110mmHg)

Question 12

PCR level in PET

Answer 12

Level of 30mg/nmol = 0.3g/24h protein excretion

Question 13

PCR level in PET

Answer 13

Level of 30mg/nmol = 0.3g/24h protein excretion

Question 14

Sx of magnesium toxicity

Answer 14

Respiratory depression and hypotension

Preceded by loss of patellar reflexes, which are tested regularly

Question 15

ECG changes in pregnancy

Answer 15

ECG changes = LAD and T wave inversion

Question 16

Thromboprophylaxis in pregnancy?

Answer 16

LMWH

Question 17

What drug is given alongside anti-epileptics from week 36?

Answer 17

10mg vit K given from 36 weeks onwards

Question 18

 Acute hepatorenal failure, DIC and hypoglycaemia  high maternal and fetal mortality
 Extensive fatty change
 Malaise, vomiting, jaundice and vague epigastric pain (first sx = thirst)
 Early diagnosis and promt delivery essential
 Correction of clotting defects and hypoglycaemia required first
 Tx: supportive, dextrose, fluid balance, dialysis

Answer 18

Acute Fatty Liver

Question 19

lupus anticoagulant and/or anticardiolipin antibodies

Answer 19

Antiphospholipid Syndrome

Question 20

Criteria for APLS

Answer 20

Diagnosis

1+ clinical criteria
o Vascular thrombosis
o 1+ death of fetus >10 weeks
o PET or IUGR requiring delivery <34 weeks
o 3+ fetal loss <10 weeks, otherwise unexplained

With laboratory criteria measured twice >3 months apart
o Lupus anticoagulant
o High anticardiolipin antibodies
o Anti-B2 Glp I ab

Question 21

Diagnosis

1+ clinical criteria
o Vascular thrombosis
o 1+ death of fetus >10 weeks
o PET or IUGR requiring delivery <34 weeks
o 3+ fetal loss <10 weeks, otherwise unexplained

With laboratory criteria measured twice >3 months apart
o Lupus anticoagulant
o High anticardiolipin antibodies
o Anti-B2 Glp I ab

Answer 21

Criteria for APLS

Question 22

Preg SE of paroxetine?

Answer 22

Paroxetine -> cardiac defects

Question 23

 Not teratogenic
 Use associated with PTD, IUGR, stillbirth, SIDS and developmental delay

Which recreational drug?

Answer 23

Opiates

Question 24

Which recreational drug?

 Teratogenic
  Risk cardiac defects and gastroschicosis
 Pregnancy complications are similar to cocaine

Answer 24

Ecstasy

Question 25

Which recreational drug?  Associated with facial clefs  Cause neonatal hypotonia and withdrawal sx

Answer 25

BDZ

Question 26

Which recreational drug?  Associated with other drug use makes it higher risk  May cause IUGR and affect child development

Answer 26

Cannabis

Question 27

``` o Facial abnormalities o IUGR o Small or abnormal brain o Developmental dlay o Usually >18 units/day alcohol exposure ``` Which recreational drug?

Answer 27

Alcohol

Question 28

 Dose-response manner   risk miscarriage, IUGR, PTD, placental abruption, stillbirth and SIDS  Associated with childhood illness  PET is more severe if assoc.  Consider high risk if women do not stop Which recreational drug?

Answer 28

Tobacco

Question 29

Blood volume increases by how much in pregnancy?

Answer 29

40% increase in blood volume   red cell mass and net fall in Hb concentration

Question 30

AntiD dose 28w

Answer 30

AntiD (1500IU) should be given to all Rh –ve women at 28 weeks

Question 31

Bleeding from the genital tract after 24 weeks gestation

Answer 31

Antepartum Haemorrhage

Question 32

Delivery MUST be via (elec) CS?

Answer 32

Placentae praaevia

Question 33

SGA definition

Answer 33

Weight of fetus is <10th centile for gestation (at term = <2.7kg)

Question 34

Weight of fetus is <10th centile for gestation (at term = <2.7kg)

Answer 34

SGA

Question 35

How long should the first stage of labour be?

Answer 35

<12hrs

Question 36

How long should the second stage of labour be?

Answer 36

40 mins - nulliparous 20 mins - multiparous >1hr likely to need assistance

Question 37

Do frogs in canada ride in a pink limo?

Answer 37

``` Descent Flexion Internal rotation Crowning Restitution Internal rotation of the shoulders Anterior shoulder Posterior shoulder Lateral flexion ```

Question 38

Average time stage 3 of labour

Answer 38

15 mins

Question 39

What is mendelsons syndrome?

Answer 39

Aspiration of stomach contents under GA

Question 40

Keilland’s forceps

Answer 40

Occipito-posterior position

Question 41

Scalp pH <7.20 (capillary) indicates...

Answer 41

...significant hypoxia

Question 42

Name a systemic opiate used during delivery

Answer 42

```  Pethidine  Meptid  Occasionally diamorphine  Given as IM injections ```  Can be self- administered ```  Can cause sedation, confusion and feeling ‘out of control’  Antiemetics also needed  Causes respiratory depression in newborn – requires reversal with naloxone ```

Question 43

3 methods of anaesthesia in labour

Answer 43

``` Spinal  Injection through dura mata into CSF  Produces short-lasting but effect analgesia ```  Method of choice for CS or mid- cavity instrumental delivery if no ``` epidural in situ  Complications = hypotension, total spinal analgesia and respiratory paralysis Pudendal Nerve Block  Local anaesthetic injected bilaterally around pudendal nerve where is passes ischial spine  Low cavity instrumental deliveries Epidural Anaesthesia  Injection of local anaesthetic via epidural catheter into epidural space  Between L3 and 4  Local anaesthetic infused continuously or to ‘top up’ intermittently  Complete sensory and partial motor blockade is the norm ```

Question 44

Complications of epidural

Answer 44

o Spinal tap affects 0.5% o Puncture of dura mata  leakage of CSF and severe headache o Pain worse when sitting up o Treated with analgesia o ‘Blood patch’ to seal the leak o Inadvertent IV injection  convulsions and cardiac arrest o Inadvertent injection of local anaesthetic into CSF + progression up SC  total spinal paraesthesia Must also monitor urination - no sensation to bladder. Encourage frequent urination

Question 45

Absolute contraindications to induction of labour?

Answer 45

```  Acute fetal compromise  Abnormal lie  Placenta praevia  Pelvic obstruction e.g. mass or deformity  cephalopelvic disproportion  >1 CS ```

Question 46

VBAC contraindications

Answer 46

 Usual contraindications for CS  Vertical uterine scar  Multiple previous caesarean  After two CS, seldom attempt VD

Question 47

Zanavelli manoeuvre

Answer 47

replacement of the head and caesarean section - dystocia

Question 48

replacement of the head and caesarean section

Answer 48

Zanavelli manoeuvre:

Question 49

pressure on anterior and posterior shoulder to rotate shoulders from transverse position

Answer 49

Wood’s screw manoeuvre

Question 50

Wood’s screw manoeuvre

Answer 50

pressure on anterior and posterior shoulder to rotate shoulders from transverse position

Question 51

How long is lochia normal?

Answer 51

Lochia (uterine discharge) may be blood-stained for 4 weeks, but is thereafter yellow or white  Menstruation is usually delayed by lactation (6 weeks after if not lactating)

Question 52

What two hormones control milk secretion?

Answer 52

 Prolactin from anterior pituitary stimulates milk secretion o High at birth o Rapid decline in E2 and P4  milk secreted o Prolactin antagonised by E2/P4  Oxytocin from posterior pituitary stimulates ejection

Question 53

What is colostrum?

Answer 53

Colostrum – yellow fluid containing fat-laden cells, proteins (IgA) and minerals o Passed for first 3 days before milk

Question 54

Mild depression, how many core + bio?

Answer 54

MILD: 2 core + 2 bio

Question 55

Mod depression, how many core + bio?

Answer 55

MODERATE: 2 core + 6 bio

Question 56

Severe depression, how many core + bio?

Answer 56

SEVERE: ≥8 symptoms, inc all 3 core

Question 57

Organic / physical causes of depression?

Answer 57

Physical causes: hypothyroid, head injury, cancer, quiet delirium, meds etc Adjustment disorder: following a life event, but not as severe Normal sadness: part of life! Bereavement: becomes a concern when grief (numbness, pining, depression, recovery) is extremely intense, prolonged (>6/12) or delayed

Question 58

Can you stop antidepressants immediately?

Answer 58

Antidepressants cannot be stopped suddenly, wean over weeks, SSRIs increased risk of bleeding, especially in older people (consider prescribing gastroprotective in older people who are also taking NSAIDs or aspirin)

Question 59

What distinguishes type 1+2 bipolar?

Answer 59

*Classification: Type I – manic episodes interspersed with depressive episodes, Type II- mainly recurrent depressive episodes, less prominent hypomanic episodes, Rapid cycling BPAD - ≥4 affective episodes in a year, women, respond better to valproate *MIXED EPISODE: manic/hypomanic + depressive symptoms in a single episode, present every day for at least a week (ICD-10) *Ultra-rapid cycling: fluctuations over days or even hours

Question 60

Support groups for bipolar?

Answer 60

``` Bipolar UK MIND SANE RETHINK Samaritans ```

Question 61

Delusion definition

Answer 61

Delusion – false, fixed belief that the patient has and is convinced by contrary to the evidence and rational argument that cannot be explained by the patient’s cultural, religious or educational background.

Question 62

Neurodevelopmental aetiology of schizophrenia?

Answer 62

Neurodevelopmental: enlarged ventricles, overall smaller/lighter brains, no gliosis ( changes before adulthood). Further evidence: low pre-morbid IQ, poor learning/mem/executive function. Early brain damage/abnormalities imperceptible at first, more pronounced as brain matures through ongoing myelination and synaptic pruning.

Question 63

What is the dopamine hypothesis in schizophrenia?

Answer 63

Neurotransmitters: dopamine hypothesis –POSITIVE symptoms from EXCESS dopamine in MESOLIMBIC tracts, NEGATIVE symptoms from REDUCED dopamine in MESOCORTICAL tracts. Serotonin hyperactivity, gluatamate dyfunction too

Question 64

List the subtypes of schizophrenia

Answer 64

Paranoid: delusion & hallucination Hebephrenic: Affective changes (extension of prodrome) Disorganised speech behaviour (silly/shallow), flat/inappropriate affect Catatonic: Psychomotor disturbance (treat with BZDs) Undifferentiated: Meets criteria but no specific dominant symptom Post-schizophrenic depression: Some residual symptoms, but depression mainly Residual: Previous +ve symptoms decreased, - ve symptoms prominent Simple: No delusions/hallucinations, ‘defect state’ (-ve) gradually arises without an acute episode

Question 65

List typical antipsychotic SEs

Answer 65

 Typical antipsychotics Extrapyramidal side effects o Acute dystonia: early onset (hours), involuntary, painful sustained muscle spasm eg torticolllis, oculogyric crisis; tongue and sternocledomastoid mostly  tx with anticholinergic iv procyclidine o Akathisia: hours –weeks, unpleasant restlessness of usually lower limbs  change/↓ dose; add propranolol or BDZ o Parkinsonism: days-weeks, triad: resting tremor, rigidity, bradykinesia  change/↓ dose, add anticholingergic (procyclidine iv) o Tardive dyskinesia: months-years; rhythmic involuntary movemetns, continuous slow writhing movements, esp oral-lingual/limbs, tend to be irreversible  /stop antipsychotic, avoid anticholinergic (worse), atypical SSRI/clozapine  ! Neuroleptic malignant syndrome: muscle stiffness and rigidity, altered consciousness, disturbance of autonomic (feve, tachy, labile BP), raised CK and WCC, acute renal failure secondary to rhabdomyolysis can  death. Normally when changing/increasing dose of drug. Tx: immediately stop antipsychotic, medical ward, hydration & oxygen, monitoring, dantrolene and bromocriptine

Question 66

List the atypical antipsychotics SEs

Answer 66

Atypical antipsychotics (metabolic syndrome, weight gain) : Olanzapine – helps with positive symptoms ( but causes weight gain) Quietiapine – qt prolongation – need ECG Risperidone – may increase prolactina and aggression Aripiprazole – expensive but no side effects (use in patients with metabolic syndrome)

Question 67

Clozapine MoA?

Answer 67

Clozapine  Blocsk D1 and D4 receptors, superiority due to added blockade of 5HT2 receptors and increased GABA turnover  Anticholinergic, antihistaminic, anti-adrenergic side effects: constipation, fever, BP derangement, sedation, seizures, weight gain etc

Question 68

SEs of clozapine

Answer 68

Anticholinergic, antihistaminic, anti-adrenergic side effects: constipation, fever, BP derangement, sedation, seizures, weight gain etc Many interactions: lithium (↑seizure risk, anticholinesterase inhibitors, smoking increases clearance  ↓ plasma conc, plasma conc ↑by caffeine  C/I: previous/current neutropenia or blood dyscrasias, previous MI/pericarditis.cardiomyopathty, liver disease  Greatest worry is fatal agranulocytosis- leukopenia, eosinophilia, leucocytosis  regular blood tests for WCC (weekly for 18 weeks  fortnightly until 1 year  monthly indefinitely) . Fatal myocarditis/cardiomyopathy/pulmonoary embolism aslo a worry.  Evidence is that it REDUCES mortality in schizo by ↓ suicide!

Question 69

Define schizoaffective disorder?

Answer 69

Both features of schizophrenia and affective disorder, 50:50

Question 70

Define SCHIZOTYPCAL DISORDER

Answer 70

‘ Partial expression’ of the schizophrenia phenotype. Classified along with schizophrenia in ICD-10, Cluster A with odd-eccentric personality disorder in DSM-IV. No hallucinations and delusions.

Question 71

Define SCHIZOPHRENIFORM DISORDER

Answer 71

Schizophrenia-like psychosis that fails to fulfil duration criterion for schizophrenia in DSM-IV

Question 72

Transient ‘state of shock’ lasting minutes-hours, max 1-3 days. Anxious but may seem dazed, may experience amnesia, depersonalisation and derealisation, may stop talking)

Answer 72

Acute stress reaction

Question 73

Associated with persistent fear & prominent avoidance of the feared situation, anticipatory anxiety attacks and insight that the fear is irrational and disproportionate to the risk. Think of impact on daily functioning. May be so severe that it induces panic attack

Answer 73

Phobic anxiety disorders

Question 74

Fear of being unable to easily escape to a safe place (e.g. home). May manifest in open spaces, or confined spaces that are difficult to leave without attracting attention. 95% have current or past diagnosis of panic disorder. Onset in mid twenties or thirties

Answer 74

Agoraphobia

Question 75

Fear of being criticised or scrutinised; worry that they will be embarrassed in public. Will tolerate an anonymous crowd (unlike agoraphobics) but small groups (e.g. meetings/dinner parties) are intimidating. May have specific worries e.g. eating in public. Self-medication with alcohol or drugs serves as avoidance and therefore perpetuates problem.

Answer 75

Social phobia

Question 76

‘episodic paroxysmal anxiety’. Not restricted to certain situations (i.e. not phobic) or objective danger. Patients may develop fear of having further attacks – ‘anticipatory anxiety’. Many also have agoraphobia. ‘Panic’ can persist until patients receives reassurance or reverts to ‘safety behaviours’: actions to avoid catastrophe, e.g. calling ambulance, taking aspirin.

Answer 76

Panic disorder

Question 77

Transient ‘state of shock’ lasting minutes-hours, max 1-3 days. Anxious but may seem dazed, may experience amnesia, depersonalisation and derealisation, may stop talking)

Answer 77

Acute stress reaction

Question 78

Abnormal psychological changes to adversity. May follow common life changes. o Onset within weeks and lasts less than 6mths o Symptoms of anxiety and depression, without the biological symptoms of depression. None of the symptoms should be of sufficient severity or prominence in its own right to justify a more specific diagnosis.

Answer 78

Adjustment disorder

Question 79

Organic DDx to rule out in anxiety disorders?

Answer 79

``` For anxiety, rule out endocrine – phaeo (urinary catecholamines), hyperthyroid (TFTs); neuro – b12 deficiency; metabolic – hypoglycaemia. Porphyria; cardio- arythmia, AF, mitral valve prolapse; substance misuse – alcohol withdrawal (LFT – GGT), smoking withdrawal ```

Question 80

1st line Rx for PTSD

Answer 80

First line treatment is trauma-focussed CBT and EMDR ____________ ``` Medicate if there is severe ongoing threat, or if patient is too distressed for psychotherapy, or if psychotherapy fails SSRIs (paroxetine, sertraline) Sleep disturbance – mirtazapine, levomepromazine, Anxiety/hyperarousal – BDZ (clonazepam), busiprone, antidepressants, propranolol Intrusive thoughts – carbamazepine, valproate, topiramate, lithium Psychosis – olanzapine, risperidone, quetiapine, clozapine, aripiprazole ```

Question 81

Anxiety-producing obsessions which they try to relieve with rituals (compulsions). These must cause distress or interfere with the person’s social or individual functioning (usually by wasting time) and should not be the result of another psychiatric disorder.

Answer 81

OCD (duration >2w) Obsessions – involuntary thoughts, images or impulses which are: 1. Recurrent and intrusive (unpleasant/distressing) 2. Enter mind against conscious resistance 3. Patients recognise obsessions as being the product of their own mind even though they are involuntary and often repugnant Compulsions – repetitive mental operations or physical acts with the following characteristics: 1. Feel compelled to perform them in response to their own obsessions or irrationally defined rules 2. Performed to reduce anxiety through belief they will prevent a dreaded event, even though they are not realistically connected to the event

Question 82

What is a compulsion?

Answer 82

Compulsions – repetitive mental operations or physical acts with the following characteristics: 1. Feel compelled to perform them in response to their own obsessions or irrationally defined rules 2. Performed to reduce anxiety through belief they will prevent a dreaded event, even though they are not realistically connected to the event

Question 83

Define an obsession?

Answer 83

Obsessions – involuntary thoughts, images or impulses which are: 1. Recurrent and intrusive (unpleasant/distressing) 2. Enter mind against conscious resistance 3. Patients recognise obsessions as being the product of their own mind even though they are involuntary and often repugnant

Question 84

What conditions is OCD associated with?

Answer 84

BIO Affected by illnesses in which risk of OCD is increased: Sydenhem’s chorea, encephalitis lethargica, Tourette’s syndrome. Strep throat infection may produce anti-basal ganglia antibodies (c.f. streptococcal infection causing Sydenham’s chorea). Neuroimaging has shown deficit in frontal-lobe inhibition – intrusive/ritualistic thoughts might be harder to suppress in OCD. PSYCH 1. Anankastic personality traits: rigidity, orderliness. ¼ of OCD patients have premorbid anankastic personality traits. 2. Stress: may precipitate OCD symptoms

Question 85

Syndrome characterised by acute onset of fluctuating cognitive impairment (or deterioration in pre existing cognitive impairment) associated with behavioural abnormalities.

Answer 85

Delerium

Question 86

Causes of delirium?

Answer 86

1. Infective: UTI, chest infection, abscess, cellulitis, subacute bacterial endocarditis 2. Metabolic: anaemia, electrolyte disturbance, hepatic encephalopathy, uraemia, cardiac failure, hypothermia 3. Intracranial: CVA, head injury, encephalitis, primary or metastatic tumour, raised ICP 4. Endocrine: pituitary, thyroid, parathyroid, adrenal disease, hypoglycaemia, DM, vitamin deficiencies 5. Substances: intoxication or withdrawal of alcohol, BDZ, anticholinergics, psychotropics, lithium, antihypertensives, diuretics, anticonvulsants, digoxin, steroids, NSAIDs Always consider the ‘great cerebral masqueraders’: TB, neurosyphilis, AIDS

Question 87

DDx for delirium?

Answer 87

Wernicke’s encephalopathy – which is a medical emergency  Korsakoff’s psychosis  Mood disorder  Functional psychiatric conditions (mania, depression, late onset schizophrenia)  Responses to major stress, dissociative disorders  Dementia (hard to differentiate as people with established dementia are vulnerable to delirium)

Question 88

Different seizure types

Answer 88

Generalised: involve whole cortex and lead to LOC Focal: involve one area of cortex and may become secondarily generalised. May be subclassified as simple partial or complex partial Simple partial: localised motor/ sensory features ± LOC or memory loss Complex partial: ± aura/automatism, and associated changes in conscious level

Question 89

Biological sources of epilepsy

Answer 89

1. Cerebrovascular damage 2. Cerebral tumours 3. Alcohol related seizures 4. Post traumatic seizures

Question 90

Cognitive decline, choreiform involuntary movements and personality change

Answer 90

Huntington

Question 91

What chromosome is Huntington's gene on?

Answer 91

Autosomal dominant gene on Chr 4

Question 92

Classic triad: chorea, dementia and FH of HD  Chorea: initial jerks, tics, gross involuntary movements of all parts of the body, grimacing, dysarthria. Increased one with rigidity and stiffness, positive primitive reflexes, abnormal eye movements  Cognitive impairments  subcortical dementia o Mental slowing o Impaired executive function o Speech deteriorates faster than comprehension  Psychiatric disturbances o Common in those with HD o Changes in behaviour/ personality o Affective disorders o Schiphreniform psychoses o These disturbances are not related to the severity of HD

Answer 92

HUNTINGTON’S DISEASE

Question 93

Alcohol MoA

Answer 93

Alcohol MOA: non-specific effects on neuronal cell wall fluidity and permeability, as well as enhancement of GABA-A transmission (anxiolytic), release of dopamine in mesolimbic system (‘reward’), inhibition of NMDA-mediated glutaminergic transmission (amnesic)

Question 94

Profound short-term memory loss characterised by confabulation

Answer 94

Korsakoffs

Question 95

a. Most dramatic neuropsychiatric complication b. Thiamine deficiency  mammillary body damage  ataxia, nystagmus, ophthalmoplegia, acute confusion

Answer 95

Wernickes

Question 96

3 stages of alcohol withdrawal (severity)

Answer 96

Uncomplicated alcohol withdrawal syndrome: 4-12hrs after last drink. Coarse tremor, sweating, insomnia, tachycardia, nausea and vomiting, psychomotor agitation, anxiety. ± hallucinations (transitory visual, tactile or auditory), craving for alcohol. Symptoms prolonged in heavier drinkers.  Alcohol withdrawal syndrome with seizures: 5-15% of withdrawals complicated by grand mal seizures 6-48hrs after last drink.  Delirium tremens: 1-7 days after last drink with peak incidence @ 48hrs. Severe dependence, comorbid infection and pre-existing liver damage increase risk. Features of withdrawal and additionally: clouding of consciousness, disorientation, amnesia for recent events, psychomotor agitation, visual, auditory and tactile hallucinations (Lilliputian hallucinations of diminutive people or animals), marked hour by hour fluctuations (worse at night), if severe there is heavy sweating, fear, paranoid delusions, agitation, suggestibility, temperature and sudden CV collapse. Reported mortality 5- 10%

Question 97

BDZ used in alcohol detox?

Answer 97

Chlordiazepoxide (lowest abuse potential)

Question 98

Lady has a diagnostic laparotomy. She has suprapubic pain that not even IV paracetamol is helping. What is the likely reason?

Answer 98

Urinary retention

Question 99

Somali lady comes in doesn’t speak much English says she's 42 weeks. Examination of abdomen suggests a 32 week uterus. Admit her to ward for ANC tomorrow do HIV test as HIV babies tend to be small, Induce her labour now, do a transabdominal scan

Answer 99

do a transabdominal scan

Question 100

Leading cause of maternal death in UK

Answer 100

Heart disease remains the leading cause of women dying during pregnancy or up to six weeks after giving birth, followed by blood clots. Maternal suicide is the fifth most common cause of women’s deaths during pregnancy and its immediate aftermath, but is the leading cause of death over the first year after pregnancy. However, there are striking inequalities: black women are five times and Asian women two times more likely to die as a result of complication

Question 101

Management of 4 year old with enuresis - dry by day.

Answer 101

Ans: reassure. (Enuresis is a problem over the age | of 5)

Question 102

Child with Downs has an NJ tube at home. It comes out and needs re-inserting. Who should put it back in? [Community paeds nurse; Community Paediatrician; Hospital Nursing staff; GP, healthworker]

Answer 102

Hospital Nursing staff

Question 103

You’re the duty GP. Mum calls about child with fever/non-blanching rash. What do you do/advise? [Go to their home with you bag to give IM benpen; Arrange an emergency ambulance to take em hospital; Tell them to go to A&E; Tell them to make an appointment with GP)

Answer 103

Arrange an emergency ambulance to take em hospital

Question 104

Child diagnosed with functional abdo pain. Associated with school. What’s the best management plan? [Encourage her to go to school and come back when her tummy starts to hurt; Have her work sent home whilst she still having pains; Change school; Make her go to school regardless of tummy pains, give her home tutoring]

Answer 104

Make her go to school regardless of tummy pains

Question 105

Child is slow to get dressed. Likes to arrange his toys in a particular way. [ASD; OCD; Oppositional defiant disorder etc]

Answer 105

ASD

Question 106

Child is an arsonist. Gets in fights. Attacks teachers. What is he likely to have at age 20? [Conduct disorder; ADHD, Dissocial personality disorder; Oppositional defiant disorder]

Answer 106

Conduct

Question 107

Neonate. Ortolani test positive. What you do? [Hip ultrasound at 12 weeks; Hip ultrasound at 6 months; Hip x-ray at 12 weeks; Hip ultrasound at 6 months]

Answer 107

12 = best answer Before 6 months of age, ultrasound is preferred over radiographs for evaluation of DDH due to insufficient ossification of the hip. In the absence of clinical findings, ultrasound should be delayed until about 6 weeks of age to reduce false positive results.

Question 108

Child with downs in residence. Short term history of attacking people, anger outbursts etc. Best management? [Give antipsychotics; Move her to new home; Send her for neuropsychiatric assessment/therapy; Give antidepressant]

Answer 108

Send her for neuropsychiatric assessment/therapy

Question 109

Asthmatic child in A&E. Mother has been giving two puffs of salbutamol with spacer every 4 hours. Description given correlated to severe asthma. What your management? [Inhaled nebs; inhaled adrenaline, Discharge; 10 puffs of salbutamol through spacer]

Answer 109

Inhaled nebs

Question 110

Child has inspiratory stridor (doesn’t explicitly state, but gives a description implying this) since birth. Likely cause?

Answer 110

[Laryngomalacia;]

Question 111

A child with short stature. Estimated mid parental height is on 25th centile. His measurements are plotted on the chart (which was printed extremely faint. You could only make out the crosses and some of the centiles. It appeared the child was crossing multiple centiles since young age). What is the cause? [Constitutional delay; Malabsorption; Hypothyroidism; Familial short stature]

Answer 111

Malabsorption;

Question 112

Hyperactive child at home. Doesn’t pay attention at school. Diagnosis?

Answer 112

ADHD

Question 113

Child takes 4 tablets of grandmothers benzodiazepines 4 hours ago. She’s currently asleep, but was fully awake with GCS 15. Your next step? [Activate charcoal; Gastric Lavage; IV flumenazil; admit for monitoring]

Answer 113

admit for monitoring Only give with rest depression

Question 114

Afebrile child with D+V. Description alludes to shock. She is 15kg. What do you give her initially?

Answer 114

[300ml bolus of 0.9% saline]

Question 115

What defines a mild learning disability? [IQ: <80/<70/<60/<50/<30]

Answer 115

<70

Question 116

Which of the following is not an RF for suicide? [FHx of depression; FHx of suicide; Prev suicide attempt; Male; Heroin-use]

Answer 116

FHx of depression

Question 117

75 yr lady bought in with daughter. “She” (not sure who it was referring to) says is anxious, being increasingly forgetful lately, thinks she has dementia. Diagnosis?

Answer 117

A: Depression.

Question 118

You’re a GP. Elderly person presents with a history of the classical signs of Alzheimer’s. What do you do next? [Prescribe donazepil; refer to memory clinic; MRI head; reassure]

Answer 118

memory clinic

Question 119

What bloods would you test for, to monitor Lithium toxicity? [U&E/Lithium levels/TFTs, Lithium levels, TFTs, Nothing unless symptomatic, U&E/Lithium, TFT/Lithium]

Answer 119

U&E/Lithium levels/TFTs

Question 120

A person with a diagnosis of Bulimia nervosa. BMI 22. Wants to get help. Management? [CBT; CBT+ Fluoxetine; Fluoxetine; Psychoanalytic therapy]

Answer 120

CBT

Question 121

A teenage girl takes an OD of paracetamol after being “dumped” by boyfriend. Which feature is likely to suggest further suicide risk? [She got dumped for another girl; She took the OD in front of him saying she wanted to teach him a lesson; N-acetyl cysteine was required; she felt hopeless]

Answer 121

she felt hopeless

Question 122

Elderly lady consented for operation by GP. Day of op decides not to have it but son insists she should go ahead. What should the doctor do. Options: [act in best interests; take word of the son as consent; assess the patient's capacity;]

Answer 122

assess the patient's capacity

Question 123

When interviewing a recovered Schizophrenic, what on MSE would make you think they were getting relapse? [Visual hallucination; being withdrawn;]

Answer 123

Visual hallucination

Question 124

Lady with social phobia. What feature would typically be associated with it? [Not liking big trains, people noticing you blush]

Answer 124

people noticing you blush

Question 125

3. Paeds derm treatment – also featured in 2014 paper. Options were a load of medicated creams/lotions + no treatment required. a. Nappy rash with satellite lesions b. Nappy rash with flexural sparing c. Chicken Pox d. Scabies e. Impetigo

Answer 125

a. Nappy rash with satellite lesions [A: Clotrimazole] b. Nappy rash with flexural sparing [A: Zinc barrier cream] c. Chicken Pox [A: Do nothing?] d. Scabies [A: Permethrin] e. Impetigo [A: Fusidic Acid]

Question 126

4. Mental Health Act [Options: Section 2; Section 3; Section 4; Section 5(2); Section 5(3); Deprivation of Liberty Safeguards (DoLS); Mental capacity act; Section 135 (even explained what it was! – taking someone to a place of safety from private property); No detention required] a. Inpatient with Mania detained under section 2, reaching the end of the term. He is still not showing signs of improvement and poses a risk to himself/others. b. Neighbours concerned about a man who they haven’t seen in a while. Psych nurse goes to visit and finds him confused, aggressive etc. She calls paramedics who give an IV infusion of saline. c. Doctor in a medical ward. Patient with some psych condition.

Answer 126

a) section 3 b) no detention c) 5(2)

Question 127

5. Multiple pregnancies – [Options: Monochorionic; Monoamniotic; Dichorionic; Molar pregnancy; Twin-twin transfusion;] Two fetal poles, one gestational sac Snowstorm appearance

Answer 127

a) monochorionic | b) molar

Question 128

7. Paeds joint problems a. Child bought in by grandmother. Said to have knocked knee in cupboard which has become swollen. His brother had swelling having banged head when he was young. b. Child with posterior rib fractures and some other patterns of injuries c. Girl with painful hot swollen knee joints. PMH of hot/swollen/painful wrist. d. Girl not able to weight bear. Recently recovered from viral illness. e. Girl not able to weight bear. Some joint(s) hurt. Mum has rheumatoid arthritis.

Answer 128

a) [Haemophilia] b) [NAI] c) [Septic arthritis] d) [Post-viral synovitis] e) [JIA]

Question 129

11. Paeds milestones - what age would you expect most children to have achieved these? a. Smiling b. Sitting unsupported - c. Walking - d. 2-3 word sentences e. Pincer Grip

Answer 129

a) 6 weeks b) 7/8months Sits without support (Refer at 12 months) c) 13-15 months Walks unsupported (Refer at 18 months) d) 3 years = 3-5 word sentences e) 12 month Good pincer grip, early 9 months

Question 130

12. Jaundice [The usual options: ABO incompatibility; Biliary atresia; Physiological; Sepsis; Criggler-najjar etc.] a. 28 day child with pale stools. b. Child is blood group O. Mother is blood group AB. c. Mum had group B strep. d. A child who had jaundice for a few days (day 2-7). He’s fine now.

Answer 130

a) biliary atresia b) ABO incompatibility c) Sepsis d) physiological

Question 131

13. Child with funny turns [Options: Infantile spasms; Reflex anoxic seizures; Breath holding attacks; Absence seizures ] a. ~8 month who keeps clenching fists and bringing arms out towards parents. b. Child falls. Parents pick him but has a tonic-clonic seizure. Is complete well afterwards. c. Child at school. Complains of unusual smell. Then seems to ‘space out’. Afterwards she’s very drowsy and sleeps for a few hours in the school nurses office. She has no recollection of what happened.

Answer 131

a) infantile spasms Wests = developmental delay, infantile spasms, hypsarrythmia b) reflex anoxic c) absence

Question 132

14. Diarrhoea [options: toddlers diarrhoea; constipation with overflow; Crohn’s; Ulcerative colitis; .... ] a. Redcurrent jelly stools

Answer 132

Intussusception

Question 133

15. Psych | a. Student who recently finished exams found disorientated and slurring his words or similar - basically

Answer 133

alcohol excess

Question 134

16. Kids development a. MINECRAFT! 7 year old who refuses to do his homework and stays up late playing Minecraft on his iPad. Parents are worried about him.

Answer 134

Normal behaviour

Question 135

Gardasil - what 4 does it protect against. Name the one from the list: HIV, HSV1, HSV2, HPV11, HPV29?

Answer 135

6,11,16,18

Question 136

UTI in first trimester of pregnancy. What would be the safest and most effective treatment? Trimethoprim, Ciprofloxacin, Doxycycline, Cefalexin, Meropenem

Answer 136

Cefalexin

Question 137

Amenorrhoea for 4 months - what do u do?

Answer 137

Pregnancy test, FSH, need a withdrawal if PCOS

Question 138

19 year old abdo swelling, weight gain, irregular periods usually, can’t remember when last period was, denies being sexually active. What is the first test you would do?

Answer 138

Preg test

Question 139

Girl with cystic ovaries on US and something else. What other symptom would be the best indicator of her having polycystic ovaries? Dysmenorrhoea, Hirsutism, Obesity, Acne.

Answer 139

Hirsutism

Question 140

Woman with PCOS. Best medication to increase fertility.

Answer 140

Clomifene

Question 141

Woman with signs of premature ovarian failure. What test would be best to confirm this diagnosis: Oestradiol, Testosterone, FSH, LH

Answer 141

FSH

Question 142

Man with azoospermia. What would be the most likely cause? Hx of mumps, hx of testicular torsion, Varicocele

Answer 142

Varicocele

Question 143

Post menopausal woman with a PV bleed. What ix should you do? Laparotomy and hysteroscopy, outpatient US with endometrial biopsy, CT, MRI…

Answer 143

outpatient US with endometrial biopsy

Question 144

Asymptomatic woman, nulliparous, found to have a 5.4cm unilocular ovarian cyst on US, no fhx. Mgmt/Ix? USS guided cyst aspiration, laparoscopic removal of cyst, discharge and safety-net, rearrange USS in 3 months and Ca12.5 follow-up, yearly follow up

Answer 144

If pre menopausal – yearly follow up as over 5cm… Women with simple ovarian cysts of 50–70 mm in diameter should have yearly ultrasound follow-up and those with larger simple cysts should be considered for either further imaging (MRI) or surgical intervention.

Question 145

Lady with cyclic pain 1 week before her period starts, trying for a baby for one year Diagnosis?

Answer 145

endometriosis

Question 146

Woman 8 weeks after normal vaginal delivery and second degree tear, still bleeding and mild lower pelvic pain. Diagnosis? Normal menstruation, PID, endometritis, lochia.. (lochia for 2-6weeks, period returns 6-8 weeks)

Answer 146

endometritis

Question 147

What is a 23 week USS useful for? Nuchal thickness for Down’s, congenital heart disease identification, predicting position of placenta at term..

Answer 147

congenital heart disease identification NORMALLY 18-20 weeks

Question 148

What causes increased urinary volume and frequency in the first trimester? Increased GFR, pressure of uterus on bladder, glycosuria.

Answer 148

pressure of uterus on bladder

Question 149

Effect of taking fluoxetine during pregnancy on baby?

Answer 149

Persistent pulmonary hypertension of the newborn,

Question 150

Woman with Nexplanon. Most likely reason for wanting to change contraceptive? Weight gain, acne, mood swings,

Answer 150

irregular bleeding

Question 151

Pregnant lady being domestically abused by husband and scared to go home. What do you do in GP? Send her home and ask her to come back with husband, give her a leaflet about domestic abuse, call and arrange emergency accommodation

Answer 151

call and arrange emergency accommodation

Question 152

Woman with a slow growing painless lesion on labia.

Answer 152

Genital warts

Question 153

Woman with tender lump inside her vagina.

Answer 153

Bartholins cyst

Question 154

Young woman, pain during sex, ‘Strawberry cervix’ on examination

Answer 154

TV

Question 155

Woman with cheesy white discharge

Answer 155

candida

Question 156

Old woman complaining of superficial dyspareunia

Answer 156

atrophic vagina

Question 157

HRT options: COCP, Oral Oestrogen, Oral Progesterone, Transdermal oestrogen, Transdermal progesterone, all have continuous or cyclical, Bisphosphonates, Testosterone. Women who has gone through menopause, had a hysterectomy. Wants HRT mainly to prevent osteoporosis and treat her hot flushes. Doesn’t want to take tablets. Swimmer wants to treat hot flushes, doesn’t want a patch. Woman with premature ovarian failure, wants to have periods. Woman who just wants to treat osteoporosis, 62.

Answer 157

Transdermal oestrogen Oral both (either cyclical or continuous depending on last period ) COCP or cyclical combined HRT (likely to have a bleed but not guaranteed) bisphosphonates

Question 158

Breast Option: mastitis, intraductal papilloma, malignancy, abscess, genital warts, Bartholins cyst Lady high White cell count, fever, lump in breast General breast tenderness - left sided, breastfeeding Small slow growing lesion on labia, pregnant lady Small painful lump inside vagina of sexually active woman

Answer 158

abscess mastitis genital warts bartholins

Question 159

Bacteria causing acne?

Answer 159

Propionibacteria acnes

Question 160

Kid with history of anal fissure - what is your first cause of action? - inspect anal region, do DRE with little finger

Answer 160

inspect anal region

Question 161

A level student has recently come back from nigeria, with symptoms of jaundice, mild anaemia and fever with malaise,arthralgia.

Answer 161

Malaria

Question 162

Kid has pain in outer ear, ear was protruding outwards, and there was a lump behind his ear.

Answer 162

Mastoiditis

Question 163

Kid with temp of 39, cap refill 6s, generally unwell + bulging fontanelles, no description of rash. Options: Meningococcal septicamia, uti, pnemonia

Answer 163

Meningococcal septicamia

Question 164

4yo kid having acute asthma attack, given iv salbutamol and hydrocortisone. Sats still low, no chest sounds on auscultation. What do you do/give next? IM adrenaline, call for senior help, start atrovent

Answer 164

call for senior help

Question 165

Kid with cervical lymphadenopathy, fever, sore throat, red tongue with white spots. What does she have? Scarlet Fever, measles, chicken pox.

Answer 165

measles

Question 166

Child who had bulimia. What gives it away? (Options were dental enamel caries, striae, lacerations on wrist…) bronchopulmonary dysplasia

Answer 166

dental enamel

Question 167

4 month old, about to have 3 batch of primary vaccinations. Which would be a complete contraindication to having the vaccine? Confirmed history of pertussis as a baby, currently ill with a fever of 38.5, got a rash at site of last vaccination, severe cow’s milk allergy,

Answer 167

currently ill with a fever of 38.5

Question 168

Perianal itching especially at night. What’s the best treatment option? (Options: Mebendazole, Cotrimazole)

Answer 168

Mebendazole

Question 169

5 month old with cough, runny nose, fever. Examination of chest you hear wheeze. What’s the main pathogen that causes this RTI? Options: Streptococcus Pneumoniae, Respiratory Syncytial Virus, Mycoplasma pneumoniae

Answer 169

Respiratory Syncytial Virus

Question 170

Respiratory Disease. Options: Meconium Aspiration, Group B Strep infection, PCP pneumonia, transient tachypnoea of newborn, Surfactant deficiency, , diaphragmatic hernia. a) Heart sound not heard, scaphoid chest. b) Baby was born at 41 weeks via emergency C section due to foetal distress. Needed ventilation straight away. X ray showed hyper inflated lungs with areas of consolidation. What does he have? c) Baby born at 37 weeks, via forceps. Showing signs of resp distress. CXR shows areas of consolidation throughout. d) Prem baby, resp distress, CXR looks like ground glass.

Answer 170

Diaphragmatic hernia Meconium aspiration (mature fetus, distress caused gasping breath in) patchy opacities, hyperinflation, no air bronchograms ) GBS Surfactant deficiency

Question 171

Treatments of Paed Rashes. Options: Hydrocortisone, Permethrin, Zinc…, Anti-fungal, Histamine cream, Nothing, Nappy rash flexure sparing Nappy rash with satellite lesions Anal itch, worst at night Scabies Chickenpox

Answer 171

zinc antifungal mebendazole permethrin nothing (can use histamine cream) OR topical calamine

Question 172

Joint problems (same as 2015) Options: haemophilia, JIA, post-viral synovitis, septic arthritis, NAI Grandmother brings boy in with swollen knee. Boy’s brother died young of a minor head injury. Posterior rib fractures Unwell and not able to weight bear, fever Recent URTI - not able to weight bear

Answer 172

Haemophilia Nai septic arthritis Recent URTI - not able to weight bear post viral synovitis

Question 173

Suicide risk. What is the highest predictor of doing it again? bad relationship with mum, feeling hopeless about future, previous self harm

Answer 173

feeling hopeless about future

Question 174

80 year old man with new onset dementia, needs MRI but refuses. You need someone to make decision for him. - (options: talk to family with his permission, ask independent mental health advocate)

Answer 174

talk to family with his permission

Question 175

Guy who has visual hallucination and likely to fall over. but he is not giving consent to help regarding his falls and delirium. He wants to leave hosp. Difficult to understand what he is saying Q: what is a big reason that makes you think he does not have consent? (Options: due to lack of understanding, due to lack of processing, due to his visual hallucination, due to him not communicating properly)

Answer 175

due to him not communicating properly

Question 176

Woman on SSRI, wanted to get pregnant, was wondering what risk it may have on her baby: Stillbirth, Pulmonary htn of the newborn, delayed labour, hypoglycemia at birth.

Answer 176

Pulmonary htn of the newborn

Question 177

Woman wants to know what risk her baby has of getting schizophrenia, since the baby’s father has it. 7-9%, 12-15%, 20-25%, 1%...

Answer 177

should be 10% (48% if both parents have it)

Question 178

Woman 5 weeks postpartum feels very sad, unable to cope, teary. Dx?

Answer 178

Postnatal depression (baby blues usually pnly for 1-2 weeks)

Question 179

What blood test should be frequently done if someone is on Lithium? Thyroid function, liver function, adrenal function, FBC,

Answer 179

Thyroid function

Question 180

Guy on medication for schizophrenia get muscle rigidity, altered consciousness, high blood pressure, tachycardia. Mgmt?

Answer 180

stop antipsychotic and dantrolene and bromocriptine

Question 181

60 year old woman, short term memory loss, struggling to complete her normal daily tasks, ataxia and dysphagia. What would you see on MRI?

Answer 181

NPH most likely

Question 182

40 year old man with moderate learning disability. He has a Hb of ~6 (below the normal range). Refuses blood transfusion but happy to take oral iron therapy. What law do you use to assess his decision (or something along those lines). [Options: Common Law; Mental Capacity Act; Mental Health Act; Disability Discrimination Act; ?European Convention on Human Rights]

Answer 182

MCA Learning disability is NOT a mental health DISORDER

Question 183

Man who had come into GP for peeling of skin on his hands. Excessive hand washing 6 times daily which has got worse since his elderly father died 3 months ago following a wound infection(?) post operatively. (Options: Adjustment Disorder (lasts 6 months), OCD)

Answer 183

OCD

Question 184

Man with treatment resistant schizophrenia on clozapine, recently stopped smoking. High level of clozapine now. Most likely consequence? Agranulocytosis, seizures.. (seizures found in agranulocytosis)

Answer 184

Agranulocytosis It is well documented that cigarette smoke can induce cytochrome P450 (CYP) isoenzymes, specifically CYP1A1, CYP1A2, and CYP2E1. Because clozapine is primarily metabolized by CYP1A2 (approximately 70%), smoking can induce clozapine metabolism and abruptly stopping smoking can increase clozapinelevels.

Question 185

Definitions Options: Illusion, formication, micropsia, pseudo hallucination Person sees flower on wallpaper - sees them as moving snakes: Person sees things smaller Definition of feel insects under skin.

Answer 185

Illusion micropsia fornication

Question 186

Agitated psych patient threating violence - what do you do? (Options: talk to consultant, call the police, talk to pt)

Answer 186

talk to pt

Question 187

Diagnosis: Options: Somatic syndrome, malignancy, Munchausens, Borderline Personality Disorder 50 y woman ,constant stomach pain, had many ix eg multiple laprascopies with nothing found. Comes to A&E saying she needs another laproscopy. Young girl who has come into A&E multiple times with different presentations, nothing found for any of them. Woman with abdominal pain, weight loss, lethargy and feeling low. Man who drinks and takes some drugs. Split up with girlfriends, cutting himself.

Answer 187

Maunchausens Somatic Malignancy BPD

Question 188

1. 14 year old primary amenorrhoea + ejection systolic murmur

Answer 188

Turner’s / coarction

Question 189

2. What gives you macrosomia

Answer 189

gestational diabetes

Question 190

3. Cyclical pain, no heavy menstrual bleed, never sexually active

Answer 190

endometriosis

Question 191

4. Ethics – 14 year old pregnant, comes with sister, wants a TOP. What should you do?

Answer 191

Persuade her to tell her parents if she refuses and gillick competent, you can give her TOP.

Question 192

5. What situation would you use donor eggs?

Answer 192

POF

Question 193

6. What do you test for in Hep B infection antenatally?

Answer 193

HBsAg

Question 194

7. What is not a risk factor for primary PPH? a. B thalassaemia trait b. Retained products c. Sepsis d. Vaginal tear e. Multiparity

Answer 194

a. B thalassaemia trait

Question 195

8. At antenatal check, woman with BP 150/90, what would you do?

Answer 195

Admit and assess

Question 196

9. Urogynae – leak urine when laughing and going up stairs, initial management?

Answer 196

Pelvic floor exercise

Question 197

10. What is the treatment for a bartholian abscess

Answer 197

malsupialisation

Question 198

11. Women with previous GDM what is the best way to investigation her blood glucose? OGTT at 28w, OGTT as soon as possible after booking (later at 28 weeks if normal)

Answer 198

OGTT as soon as possible after booking (later at 28 weeks if normal)

Question 199

12. Women with APH (spotting) otherwise well, what is the most important thing to rule out? Ectopic pregnancy, placenta praevia

Answer 199

Ectopic pregnancy

Question 200

13. What type of contraception can increase risk of osteoporosis?

Answer 200

Depot injections

Question 201

14. Women with excessive vomiting, under what circumstance would you admit her?

Answer 201

Ketonuria

Question 202

15. What is likely to cause this man’s azoospermia?

Answer 202

Varicocele, Mumps orchitis

Question 203

16. Which drug is likely to be teratogenic? [antiepileptics]

Answer 203

Sodium valproate

Question 204

Someone comes in at 28w with a Hb of 10.5 what would you do?

Answer 204

Simple advice - leafy Haemoglobin levels outside the normal UK range for pregnancy (that is, 11 g/100 ml at first contact and 10.5 g/100 ml at 28 weeks) should be investigated and iron supplementation considered if indicated.

Question 205

Menopause treatment – what HRT would you give a. Premature menopause and wants a bleed b. Someone want something for their bones c. Women with menopausal symptoms, hysterectomised, does not want to take oral tablets d. Perimenopausal women with menopausal symptoms, irregular menstruation, does swimming and does not patch e. Women with menopausal symptoms and has eczema

Answer 205

cyclical HRT or cocp bisphosphonate transdermal oestrogen HRT cyclical oral HRT oral combined HRT

Question 206

2. STIs a. Clue cells b. Strawberry cervix c. Painful multiple lesions on labia d. Lichen sclerosis e. Curdy white-yellow discharge f. Blue dots on cervix

Answer 206

BV Trichomonas and wet slide herpes thin vulval epithelium, white plaques candidiasis endometriosis (blue/ dark dots) nathobian cyst – yellow dots

Question 207

a. Mother with stillborn baby, generalized oedematous when born, mother had fever at 18w with rash on trunk

Answer 207

parvovirus

Question 208

4. What is the likely diagnosis a. Smear comes back as moderate dyskaroysis b. 76 year old had a single brown discharge c. Intermittent pain + vomiting

Answer 208

CIN2 atrophic vaginitis ovarian torsion

Question 209

5. Gynae Management a. 47yo women with menorrhagia + dysmenorrhea, US showed multiple fibroids – b. 32 yo has 2 children done with family, had COCP before c. Women going away for holiday and would like to delay her periods.

Answer 209

hysterectomy mirena Norethisterone

Question 210

6. Obstetric complications a. Mother being prepared for CS, sudden tingling around her mouth? b. Mother being prepared for CS and has a regional block, sudden tachycardia, SOB, difficulty in breathing c. Mother had previous CS, sudden abdo pain and abnormal CTG d. Another anaphylaxis one

Answer 210

Spinal block anaphylaxis uterine rupture

Question 211

1. Kid with fever of >39 what to do next

Answer 211

Septic screen

Question 212

When disappear? a. Moro reflex newborns b. Asymmetrical neck reflex newborns c. Palmar and planter grasp newborn d. Rooting newborn

Answer 212

3/4 months (drop extend arms) 3months (turn and extend arm) 5/6months 4months

Question 213

3. Mother with girl who doesn’t speak

Answer 213

refer for hearing assessment

Question 214

4. Kid fitting for over 5mins, normal glucose, what do you give?

Answer 214

Rectal diazepam/ bucal midazolam/IV lorazepam if you have access

Question 215

7. Dehydration + ill kid – weight 15kg what do you give initially?

Answer 215

300ml bolus IV

Question 216

8. Aspiration pneumonia what would you do 1st?

Answer 216

ABx

Question 217

9. Strawberry tongue

Answer 217

scarlet fever

Question 218

10. What is the purpose of debriefing after a child’s death in resuscitation?

Answer 218

To address emotional needs of everyone in the team.

Question 219

11. Child who pass stool every few days, when he does go, stools are pellet like and smelly, what is the likely diagnosis?

Answer 219

Overflow constipation

Question 220

12. Child with pruritus ani worse at night, what would you give to treat?

Answer 220

Mebendazole

Question 221

1. Skin condition treatment wtf a. Impetigo b. Rash involving flexures c. Rash not involving flexures d. Scapies e. Chickenpox

Answer 221

a. fusidic acid (first line)/ oral flucloxacillin b. imidazole c. zinc d. permethrin e. calmamine lotion

Question 222

3. By WHAT AGE would you refer the following kids if they haven’t achieve the following milestones a. Sit without support b. Walk c. Hops on one leg d. Pincer grip e. Smiles

Answer 222

3. By WHAT AGE would you refer the following kids if they haven’t achieve the following milestones a. Sit without support – normally by 6m with round back, refer by 8m (limit age 9 months) b. Walk – normally by 15m, refer by 18m (limit age 18 months) c. Hops on one leg – normally by 4y, refer by 5y (5y was the only upper limit answer) d. Pincer grip – normally by 10m, refer by 12m (limit age 12 months) e. Smiles – normally by 6w, refer by 8w (limit age 8 weeks)

Question 223

4. Poisons + investigations a. Drunk/ intoxicated kid b. Dehydrated, seizures, mother been giving some herbal oral rehydration fluid or something c. Sick kid with fever, vomiting, photophobia

Answer 223

a. Drunk/ intoxicated kid – urine drug screen b. Dehydrated, seizures, mother been giving some herbal oral rehydration fluid or something – check plasma sodium c. Sick kid with fever, vomiting, photophobia - LP

Question 224

5. Respiratory problems a. Neonate getting progressively worse at breathing over first 3h with opacities b. Still needs oxygen c. Ground grass appearance d. Nitrogen washout test e. Meconium aspiration

Answer 224

5. Respiratory problems a. Neonate getting progressively worse at breathing over first 3h with opacities - Group B strep pneumonia b. Still needs oxygen - Bronchopulmonary dysplasia c. Ground grass appearance - Respiratory distress syndrome/ primary surfactant deficiency d. Nitrogen washout test – congenital heart disease (after all that revision this was the only question that came up. Great) e. Meconium aspiration – asymmetrical patchy, opacities

Question 225

6. Childhood malignancies presentation a. Nephroblastoma, same as Wilms b. Retinoblastoma c. Osteoid sarcoma d. ALL e. Posterior fossa tumour

Answer 225

a. Nephroblastoma, same as Wilms – before 5, large abdo mass b. Retinoblastoma – white pupillary reflex and a squint. (chromosome 13) c. Osteoid sarcoma – painful bone d. infection, anaemia, limp, bruising e. Posterior fossa tumour – medulloblastoma

Question 226

7. Which virus caused the following conditions a. Kid with sore throat, cervical lymphademopathy, been given antibiotics, rash comes on. b. Rash that started from behind the ears and spread to trunk, parents are vegetarians and kid goes to school in north London

Answer 226

a. Kid with sore throat, cervical lymphademopathy, been given antibiotics, rash comes on. EBV b. Rash that started from behind the ears and spread to trunk, parents are vegetarians and kid goes to school in north London – measles

Question 227

8. Gastroinestional a. Intermittent pain, dehydrated, vomited 3 times b. Sudden abdo pain, well child, something indentable on the L lower quadrant c. Scaphoid abdomen (never heard of that term before until the exam!)

Answer 227

a. Intermittent pain, dehydrated, vomited 3 times - Intussesception b. Sudden abdo pain, well child, something indentable on the L lower quadrant – constipation c. Scaphoid abdomen (never heard of that term before until the exam!) – diaphragmatic hernia

Question 228

2. Ethics – 78 year old fell and sustained a fractured NoF and refuse surgery, son is a lawyer and says his mother does not have capacity, what should you do?

Answer 228

Access capacity

Question 229

3. Someone who just started on an antipsychotic and becomes tachycardia, hyperthermia, sweating, urine drug screen negative.

Answer 229

Neuroleptic malignancy syndrome

Question 230

4. Which of the following condition would a kid’s twin brother has if he was diagnosed with it?

Answer 230

ADHD

Question 231

5. Diagnosed bipolar disorder – sudden renal failure, what do you check? Lithium levels, U&Es, Thyroid

Answer 231

Lithium levels

Question 232

8. Someone is brought in by their mother to AE and appears psychotic what section would you put them under?

Answer 232

Section 2 (in emerhency could do 4)

Question 233

9. Someone with acute dystonia what would you give?

Answer 233

Procyclidine

Question 234

10. Someone with bulimia, BMI 22, well and keen to get treatment.

Answer 234

CBT

Question 235

14. Out of the following people, who is likely to commit suicide? a. Women b. People who work in managerial roles c. People who are 40-50 d. People who are married

Answer 235

c. People who are 40-50

Question 236

15. If all these children have learning disability, who is most likely to have mental disorder later on? a. Child with epilepsy b. Child with long term illness c. Child with malignancy

Answer 236

b. Child with long term illness

Question 237

18. Women with mild depression what is your management

Answer 237

CBT

Question 238

20. Women with sudden confusion what would you do first?

Answer 238

Urine dip

Question 239

21. One of the criteria for learning disability?

Answer 239

IQ <70

Question 240

1. Psychiatry drugs a. Failed 2 antipsychotics b. Someone who was started on haloperidol and has acute muscle spasm (acute dystonic) c. Someone who is aggressive and needs rapid tranqulisation d. Moderate Depression in young adult

Answer 240

a. Failed 2 antipsychotics – clozapine b. Someone who was started on haloperidol and has acute muscle spasm (acute dystonic) – procyclidine c. Someone who is aggressive and needs rapid tranqulisation – non psychotic: oral lorazepam, psychotic: lorazepam + haloperidol IM: lorazepam + haloperidol d. Moderate Depression in young adult – CBT + medication (she said citalopram)

Question 241

3. Substance misuse | a. Something that works on 5HT receptors?

Answer 241

MDMA/ ectasy

Question 242

2. Psychiatry services who to refer to? a. Who would you refer a schizophrenic patient to if they are being discharged and needs support in the community regarding treatment? b. Someone with schizo and need help organizing their activities after they are being discharged? c. Girl who overdose in front of her boyfriend after a row, no previous suicide/ self-harm attempts. Good health. Only did it because she wanted attention from her boyfriend.

Answer 242

2. Psychiatry services who to refer to? a. Who would you refer a schizophrenic patient to if they are being discharged and needs support in the community regarding treatment? Community psychiatric nurse (she said) HTT b. Someone with schizo and need help organizing their activities after they are being discharged? Occupational therapist c. Girl who overdose in front of her boyfriend after a row, no previous suicide/ self-harm attempts. Good health. Only did it because she wanted attention from her boyfriend. – GP

Question 243

40 year old premature ovarian failure and wanted medication to deal with the symptoms of menopause. What would you prescribe her?

Answer 243

HRT

Question 244

Woman is pregnant and HIV negative at booking but her partner is HIV positive - what do you do?

Answer 244

Nothing

Question 245

What signifies onset of active labour?

Answer 245

Regular contractions

Question 246

Woman with white discharge and itch. Which treatment?

Answer 246

Oral Fluconazole, Topical Clotrimazole

Question 247

Pregnant woman with itchy feet, what investigation?

Answer 247

Liver function tests 

Question 248

Results show azoospermia. How should they be managed? IVF, egg donation, ICSI, IUI

Answer 248

ICSI

Question 249

Ovarian Cysts: Options: Mature teratoma, Dysgerminoma, serous cystadenoma, endometroima ● Cyst contains hair and teeth. ● Ground glass appearance ● Woman has pain before periods and has been subfertile, cyst found on ovary.

Answer 249

● Cyst contains hair and teeth. - Teratoma ● Ground glass appearance - Endometrioma ● Woman has pain before periods and has been subfertile, cyst found on ovary - Endometrioma

Question 250

Gynae Cancer - endometiral cancer, VIN, vulval cancer, cervical cancer - Post menopausal woman has bleeding - 70 year old lady has some spotting and says she uses some steroid cream for a “rash down there” - Woman had some bleeding and curettage of the endometrium had carcinomatous change (it genuinely said this or something like this!) - Lady is on Tamoxifen, which cancer does this increase the risk of? Endometrial cancer

Answer 250

- endometiral cancer - lichen sclerosis - Endometrial cancer - Endometrial cancer

Question 251

STIs - Green discharge - White discharge

Answer 251

STIs - Green discharge- trichomonas - White discharge- candid

Question 252

Heart Disease: A newborn appears to be in severe respiratory distress and appears blue. Despite being given high flow O2, his saturations remain at 65%. What is the next best step to take with regards to his management? ● Chest X-Ray ● Infusion of Prostaglandin ● Surgery ● Indomethacin

Answer 252

● Infusion of Prostaglandin

Question 253

3 months old baby with signs of HF, systolic murmur that radiates over the praecordium

Answer 253

VSD3

Question 254

What is the most important thing to look at in follow up of HSP? ESR, FBC, urine protein and RBCs, platelets

Answer 254

urine protein and RBCs

Question 255

6 year old child with 24 hour history of left peri-orbital swelling. Had an upper respiratory tract infection last week. Left proptosis, visual acuity was normal and had a fever of 38.9. What is the best diagnostic investigation? CT of nasal orbits, USS of nasal orbits, nasal endoscopy, intraocular pressure measurement, plain x-ray of nasal sinus

Answer 255

CT of nasal orbits

Question 256

Boy with itchy bottom, what do you prescribe? Miconazole cream, mebendazole solution

Answer 256

mebendazole

Question 257

Child with 6m of loose stools. Passed one hard blood streaked stool 10 days ago. What investigation? Colonoscopy, stool mc&s, anti TTG, DO NOTHING

Answer 257

DO NOTHING

Question 258

Infant with episodes of throwing arms forward with fists clenched. Febrile seizure, focal seizure, infantile spasms, partial seizure

Answer 258

infantile spasms

Question 259

Mother worried about 2.5 or 3? year old child’s bed wetting. Dry by day, wets bed at night. What do?

Answer 259

Reassure

Question 260

Child with fever of 39, high resp rate, nurse says chest is clear, what investigation do you do? CXR, urinalysis

Answer 260

urinalysis

Question 261

Child with fever, white exudate on one tonsil, diagnosis? Tonsillitis, Quinsy, diphtheria

Answer 261

Quinsy

Question 262

Child with episodes of smelling strange things, hard to communicate with during these episodes, falls asleep for an hour after and doesn’t remember anything. Diagnosis? Focal seizure, absence seizure, tonic clonic, narcolepsy

Answer 262

Focal seizure

Question 263

Mother complains her young child is a fussy eater. She eats soft foods and drinks a lot of milk. Also has been feeling tired recently. Diagnosis?

Answer 263

Iron deficiency anaemia

Question 264

Baby is almost a month old and jaundiced. Parents say has been jaundiced since day 2. Stools are grey or white. Diagnosis?

Answer 264

Biliary atresia

Question 265

Rashes: Please match up the following pictures to the scenario described Options (Photos of): Mongolian Blue Spot, Non-blanching rash with glass test (N. Meningitidis), Periorbital cellulitis, Molluscum contagiosum, Blanching rash on the trunk, Eczema on the face ● Child suffers from fever. The fever disappears but she has now developed a rash. She subsequently has febrile convulsions. ● Child appears severely unwell with a non-blanching rash…? ● Mother with cold sores has been kissing her child who has a background of eczema? ● Child has an URTI 2 weeks ago. Has now developed a rash over the back of the legs along with joint and abdominal pain.

Answer 265

● Child suffers from fever. The fever disappears but she has now developed a rash. She subsequently has febrile convulsions. - HHV6 - Roseola Infantum, blanching rash ● Child appears severely unwell with a non-blanching rash…? - Non-blanching rash with glass test (N. Meningitidis) ● Mother with cold sores has been kissing her child who has a background of eczema? Eczema on the face ● Child has an URTI 2 weeks ago. Has now developed a rash over the back of the legs along with joint and abdominal pain. HSP

Question 266

``` Treatment for skin lesions Fusidic acid, zinc and castor oil barrier cream, 1% hydrocortisone, no treatment needed ● Nappy rash with satellite lesions ● Nappy rash sparing flexures ● Impetigo measuring 8mm ● Chicken pox ```

Answer 266

Treatment for skin lesions Fusidic acid, zinc and castor oil barrier cream, 1% hydrocortisone, no treatment needed ● Nappy rash with satellite lesions fluconazole ● Nappy rash sparing flexures zinc and castor oil ● Impetigo measuring 8mm fusidic acid ● Chicken pox do nothing

Question 267

ADHD: Child comes in Rx?

Answer 267

● Methylphenidate

Question 268

16 y o having sex with a 12 year old - what is your next action?

Answer 268

(call the police, safeguarding…)

Question 269

Boy always playing video games from teenage years, not interested in other people threatening to kill himself? Histrionic, Narcissistic Schizoid personality disorder

Answer 269

Schizoid

Question 270

Kid with spiral fracture. What do you do?

Answer 270

Admit

Question 271

Kid with petechial rashes, low RBC and raised WBC with a limp and I think and sick.

Answer 271

ALL

Question 272

Foreign kid that is drooling and something about not being vaccinated.

Answer 272

Epiglottitis

Question 273

Kid given dexamethasone for croup 12 hours ago by GP, was stable and well with good sats but still mild stridor. What else do you give? Repeat steroids, nebulised adrenaline, Inhaled salbutamol, oxygen

Answer 273

Repeat steroids,

Question 274

Kid with delayed milestones in language, GP clicked his fingers and she turned to look, what’s the next step - refer for hearing assessment, refer to SALT, refer for developmental assessment

Answer 274

refer for hearing assessment may be unilateral

Question 275

Kid with globally delayed milestones, started to walk at like 18 months, saying 2 word phrases at 3 years, 50 word vocabulary at 3 years or something and some other stuff. What would be the most useful investigation? Detailed development history, MRI, hearing test, etc.

Answer 275

Detailed development history

Question 276

Another kid with a strawberry tongue, what was the likely diagnosis?

Answer 276

scarlet fever or Kawasaki

Question 277

Kid with anal itch, what do you give?

Answer 277

Mebendazole cream

Question 278

Kid with episodes of stiffening of hands and limbs, accompanied by screaming and sweating. Kid with impaired taste stuff, then awareness and then goes to sleep for like an hour and back to normal. No memory of event. Focal seizure, atypical migraine, Absence seizure, Epilepsy, narcolepsy

Answer 278

Focal seizure

Question 279

Another kid that would fall down and scream and stuff but was completely fine afterwards.

Answer 279

Temper tantrum

Question 280

Kid with yellow and grey stools and was like 4 weeks old or something. What do you test for? Conjugated bilirubin levels (always do bilirubin first), G6PD, Coombs Test

Answer 280

Conjugated bilirubin levels (always do bilirubin first)

Question 281

Kid with bouts of crying and episodes where they flex their knees and hips and red stool.

Answer 281

intussusception

Question 282

Hypochloraemic hypokalaemic pH shown, with some clinical information. What is the initial management for it? Correct electrolyte imbalance, surgical consult, abdominal USS

Answer 282

Correct electrolyte imbalance

Question 283

Premature kid that was born distended abdomen, vomiting, episode of blood in stool

Answer 283

NEC

Question 284

Question on a kid who had bloods that demonstrated: low platelets, normal white cells and normal red cells.

Answer 284

ITP

Question 285

7 year old kid headache and secondary nocturnal enuresis. He’s lost 1.5kg. Urine dipstick normal (i.e. no glucose, proteins, blood. Specific gravity ?1.010 to 1.030) What is the likely diagnosis? Urinalysis nil (plasma osmolality not given?). Diabetes insipidus, diabetes mellitus, behavioral enuresis, constipation

Answer 285

Diabetes insipidus

Question 286

Voraciously hungry kid, hypotonia and almond eyes what was the diagnosis? Initial problems feeding, and almond eyes. Down’s, Edwards , Patau’s, Prader-Willi

Answer 286

Prader-Willi

Question 287

7 year old kid has an accident and needs to have his leg amputated below knee. He says no and wants to wait for his mum to approve first but she’s on a business trip, dad says go for it. What do you do: Apply to Court to get amputation in best interests, Proceed with the dad’s consent (assuming dad is biological and still with the wife), wait for mum to give permission, kid is gillick competent - don’t operate.

Answer 287

Proceed with the dad’s consent (assuming dad is biological and still with the wife)

Question 288

Kid with nocturnal enuresis where behavioural therapy and enuresis alarm hasn’t worked. He’s going to friends for a sleepover. What is next management? Desmopressin, restrict fluids

Answer 288

Desmopressin

Question 289

Kid soiling his pants at school, something along those lines. What was the cause for it?

Answer 289

Constipation

Question 290

3 year old kid with unilateral nasal discharge with bleeding and crust or something like that, What was the most likely cause. Foreign body insertion, nasal polyp, cancer

Answer 290

Foreign body insertion

Question 291

Another case with an unwell child where chest was clear, had a fever. Lost weight recently. What do you do next? Glucose. CXR, urine dip, ABG and some other stuff

Answer 291

Glucose | always go with ABC...DEFG approach that’s what you do FIRST

Question 292

Neonate with some cardio problem. Systolic murmur loudest at the left sternal edge 2/6. What was it, PDA, ASD, VSD, tetralogy of Fallot.

Answer 292

tetralogy of Fallot

Question 293

Kid who basically had ADHD. What is the management? CBT, Parental training, methylphenidate.

Answer 293

Parental training

Question 294

Child who has a hx of very dry skin, rash over arms, getting worse & spreading to ?extensor surfaces. Sister has itchy rash on ankles and wrists. (Sounds like Eczema) What would be the management? Fusidic acid, emollients+1% hydrocortisone, permethrin cream

Answer 294

emollients+1% hydrocortisone

Question 295

Hip pain on exercise and climbing stairs. Prolonged history, otherwise well. Perthes disease, osgood-schlater, septic arthritis

Answer 295

Perthes disease,

Question 296

3 year old Kid with hypochromic microcytic anaemia and low ferritin. What could be the cause? Folate deficiency, Thalassaemia, coeliacs, fussy eater

Answer 296

fussy eater (fussy eater common in this age, they take less iron and get anaemia, which explained the hypochromic microcytic anaemia blood film)

Question 297

Cerebral Palsy (described hemiplegic weakness with brisk reflexes), what area of the brain is affected? Motor cortex, basal ganglia, pyramidal tracts, cerebellum, internal capsule

Answer 297

Motor cortex

Question 298

Kid having 1st set of primary vaccinations, what would stop you giving it? Fever of >38.5, rash from previous vaccine, if her brother had a reaction to it

Answer 298

Fever of >38.5

Question 299

Kid with rough (i.e. sandpaper) rash on face & trunk, flushed face. No rash around mouth - scarlet fever, parvovirus

Answer 299

scarlet fever

Question 300

Kid with 2cm x 2cm neck mass (inframandibular) on L side, painful, neck mass, reactive neutrophils - blood film shows: toxic left shift with reactive neutrophilia Glandular fever, thyroglossal cyst, mump, Lymphadenitis, lymphoma, mumps

Answer 300

Lymphadenitis

Question 301

Girl with sickle cell, has 0 reticulocytes - parvovirus, acute chest syndrome, stroke, diactylitis

Answer 301

parvovirus

Question 302

Graph of paracetamol ‘overdose’, it had been 7 hours - decide what to give (was given a chart with a treatment line and a measure of something - it was below treatment line)? Activated charcoal, N-acetylcysteine, Gastric lavage, Active monitoring

Answer 302

All patients with a timed plasma paracetamol level on or above a single treatment line joining points of 100mg/L at 4 hours and 15mg/L at 15 hours after ingestion should receive acetylcysteine (Parvolex or generics) based on a new treatment nomogram, regardless of risk factors (see figure 1 below)

Question 303

Newborn with purple spot on face [Sturg-Weber], what is the next best approach? Discharge to Gp follow up, Medical photography, Clotting studies, Send urgently to A&E, MRI/CT

Answer 303

MRI/CT

Question 304

Kid needs fluids, but you can’t get standard IV access. Where do you go? Jugular, brachial, carotid, Intraosseous

Answer 304

Intraosseous

Question 305

Kid with symptoms of nephrotic syndrome - 1st line treatment? ?Steroids, albumin solution

Answer 305

Steroids

Question 306

HIV with undetectable viral load. what is contraindicated in labour? Forceps, ventouse, foetal blood sampling, c section and some other stuff.

Answer 306

foetal blood sampling

Question 307

Standard chicken pox question. Doesn’t remember she had it. What do you do? Check IgG antibodies, check IgM antibodies, give her varicella Ig, give her aciclovir

Answer 307

Check IgG antibodies

Question 308

Woman with BMI 40, abdo distension, urinary symptoms, bowel symptoms and weight loss. What could be it? Ovarian cancer, colorectal cancer, endometrial cancer etc.

Answer 308

Ovarian cancer

Question 309

60 year old woman with PMB and superficial dyspareunia, what is the MOST LIKELY diagnosis?

Answer 309

Atrophic vaginitis

Question 310

Woman had an implant inserted but she’s getting it removed. What is the most likely reason why? Weight gain, irregular bleeding , hirsutism, etc

Answer 310

Irregular bleeding

Question 311

What cancer are you at increased risk at with HRT? Ovarian, endometrial, cervical, bowel, breast, etc.

Answer 311

breast

Question 312

Cervical os is open in a young woman early pregnancy. What is it?

Answer 312

Inevitable miscarriage

Question 313

Woman with pre-eclampsia, what drug do you give her first-line? Labetalol, Nifedipine, Methyldopa, and some others

Answer 313

Labetalol

Question 314

Mother had rupture of membranes at like 32 weeks. What do you give her? IM dexamethasone, magnesium sulphate, something that began with c

Answer 314

IM dexamethasone

Question 315

Intermittent pain in a young woman not pregnant? Ovarian torsion, primary dysmenorrhoea, endometriosis

Answer 315

endometriosis | 1 in ten women endometriosis vs 1/100000 torsion

Question 316

17yr old girl wanting Emergency contraception more than 5 days after unprotected sex. Copper IUD, Levonestrogel, IUS, COCP

Answer 316

Copper IUD

Question 317

Babies head comes out but it kinda goes back in. What is the cause? Turtle neck

Answer 317

Shoulder dystocia

Question 318

Some girl with painful periods in the first 2 days of her period ever since menarche, she has heavy bleeding. What is it? Primary dysmenorrhoea, endometriosis, endometrial cyst

Answer 318

Primary dysmenorrhoea

Question 319

Pregnant woman in early pregnancy with depression and anxiety on sertraline. What do you do? Stop sertraline, carry it on, prescribe high-dose folic acid, reduce the dose

Answer 319

Carry it on

Question 320

Post partum haemorrhage with high BP - carboprost, misoprostol, ergometrine, syntocinon

Answer 320

syntocinon

Question 321

What’s the management for DVT risk in a pregnant woman or something like that who’s coming in for a planned cesarean? LMWH, LMHW and Ted stockings, Ted stockings, Warfarin or something, Aspirin, Aspirin and Ted stockings

Answer 321

LMHW and Ted stockings

Question 322

Some pregnant woman with some itch. What tests do you do?

Answer 322

Bile acids

Question 323

Woman with blocked tubes, blocked tubes on hysterosalpingogram, what treatment should you do for fertility? IVF, IUI, ICSI.

Answer 323

IVF

Question 324

Some smear question she is 47 y/o. It was borderline HPV negative, what do you do? Repeat in 6w, repeat 6m, repeat 1y, discharge to routine (2y), discharge to routine (3y)

Answer 324

discharge to routine (3y)

Question 325

Down’s syndrome person gets pregnant. Mum is like allow that and wants termination for her and Down’s person wants to keep it. What should you do? Assess patient’s mental capacity without mum present (everyone assumed to have capacity until proven otherwise so asses it)

Answer 325

Assess capacity

Question 326

Heavy periods in a girl not sexually active. What do you give her? COCP, mefenamic acid, tranexamic acid

Answer 326

tranexamic acid

Question 327

Woman with high BMI (28) who basically had stress incontinence. What’s the first line management? Pelvic floor exercises, oxybutinin, bladder training (was this an option?, weight loss and all that

Answer 327

Pelvic floor

Question 328

What do you measure at booking for hepatitis b?

Answer 328

Hep B surface antigen

Question 329

What procedure is contra-indicated in HIV pregnant woman? Foetal blood sampling, C section, forceps, ventousse

Answer 329

Foetal blood sampling

Question 330

Man with azospermia - what is the most common cause? (think this was a repeat) varicocele, mumps orchitis

Answer 330

varicocele

Question 331

Woman with offensive smelly lochia d2 post-partum, had had some high vaginal swabs? Reassure and discharge, await swab results, give antibiotics, abdo USS

Answer 331

give antibiotics

Question 332

Woman at term has just SROM’d, transverse lie clear liquid but fetal distress, why? Cord prolapse, vasa previa, placenta previa, placental abruption, uterine rupture

Answer 332

Cord prolapse

Question 333

Large mum (BMI >40), head comes out then goes back in, chin not visible. Rupture, short cord, shoulder dystocia, normal mechanism of labour

Answer 333

shoulder dystocia

Question 334

70yo w/ 2 pmbs, TVUS shows 6mm endometrium and 3 cm simple ovarian cyst. Next step? Ca125, diagnostic laparoscopy, pipelle,

Answer 334

Ca125 - all PM women with >1cm cyst = require RMI determination RMI I combines three presurgical features: serum CA-125 (CA-125); menopausal status (M); and ultrasound score (U).The RMI is a product of the ultrasound scan score, the menopausal status and the serum CA-125 level (IU/ml) as follows: RMI = U x M x CA-125. ● The ultrasound result is scored 1 point for each of the following characteristics: multilocular cysts, solid areas, metastases, ascites and bilateral lesions. U = 0 (for an ultrasound score of 0), U = 1 (for an ultrasound score of 1), U = 3 (for an ultrasound score of 2–5). ● The menopausal status is scored as 1 = premenopausal and 3 = postmenopausal. ● Postmenopausal can be defined as women who have had no period for more than one year or women over the age of 50 who have had a hysterectomy. ● Serum CA-125 is measured in IU/ml and can vary between zero to hundreds or even thousands of units.

Question 335

How to calculate RMI?

Answer 335

RMI I combines three presurgical features: serum CA-125 (CA-125); menopausal status (M); and ultrasound score (U).The RMI is a product of the ultrasound scan score, the menopausal status and the serum CA-125 level (IU/ml) as follows: RMI = U x M x CA-125. ● The ultrasound result is scored 1 point for each of the following characteristics: multilocular cysts, solid areas, metastases, ascites and bilateral lesions. U = 0 (for an ultrasound score of 0), U = 1 (for an ultrasound score of 1), U = 3 (for an ultrasound score of 2–5). ● The menopausal status is scored as 1 = premenopausal and 3 = postmenopausal. ● Postmenopausal can be defined as women who have had no period for more than one year or women over the age of 50 who have had a hysterectomy. ● Serum CA-125 is measured in IU/ml and can vary between zero to hundreds or even thousands of units.

Question 336

The very last question was a bunch of tests for a woman who couldn’t conceive- all test normal and prolactin raised by like 2 points above normal value what’s most likely cause?

Answer 336

Unknown

Question 337

Drug to give for depression in a guy who had an MI.

Answer 337

Sertraline

Question 338

Old age boxer rips out cannula, attacks staff what do you do? Calm him with verbal de-escalation, make him some tea LOL, debrief the nurses, start iv Abx

Answer 338

verbal de-escalation

Question 339

Guy on haloperidol gets muscle problems

Answer 339

give IM procyclidine

Question 340

Woman experienced trauma 6 months ago/has PTSD best management?- trauma focused cbt wasn’t option, EMDR , (cognitive analytical therapy i think was on there)

Answer 340

EMDR

Question 341

Guy works as an IT engineer, doesn’t like sex, or people

Answer 341

schizoid

Question 342

Guy worries about running kids over so has to check the road or something everytime

Answer 342

OCD

Question 343

Woman basically worries about blushing in public (buzzword)-

Answer 343

social phobia

Question 344

Guy has a fear of public speaking, worried about embarrassing himself, hasn’t seen his personal tutor, hasn’t left the house in a few? weeks, gets sick thinking about it. social phobia, agoraphobia, avoidant personality disorder (or something like that)

Answer 344

Social

Question 345

Some schizo making a scene in public and police want to detain him, which MHA?

Answer 345

136

Question 346

Alcoholic wants to quit and wants something for reducing cravings (acamprosate, naltrexone, disulfiram)

Answer 346

Naltrexone safe if they haven't already stopped

Question 347

Guy on antipsychotic comes in with tremor- most likely drug

Answer 347

haloperidol

Question 348

Child has classic symptoms of ADHD, how do you manage? Methlyephenidate, Family Therapy or CBT

Answer 348

Family Therapy

Question 349

Guy writes letters to the PM, think he’s being spied on by the government for the past 10 years, shows no other symptoms

Answer 349

Delusional disorder,

Question 350

Man with history of paranoid schizophrenia, his Ix and tests are strongly suggestive of an MI, needs treatment. He has capacity and refuses treatment - what should you do? Treat him under DoLs, treat under MCA, treat under MHA, respect his wishes

Answer 350

respect his wishes

Question 351

Lithium - what do you monitor?

Answer 351

Lithium, TFTs, U&E

Question 352

Patient on ward becomes aggressive, verbal de-escalation hasn’t worked. Tx? Oral haloperidol, oral lorazepam, IM lorazepam, IM haloperidol, IM haloperidol & lorazepam

Answer 352

IM lorazepam

Question 353

50y lady fell over gardening, comes in with paralysis of leg, no medical cause found? Conversion disorder

Answer 353

Conversion disorder