SPECIALTIES 2024 Flashcards
(143 cards)
1
Q
- Pregnant woman 34 weeks gestation at GP has proteinuria. Shows MC&S results: E coli positive, epithelial cells ++. Sensitivities: resistant to amoxicillin, sensitive to nitrofurantoin, trimethoprim and cephalexin. Mx?
a. Cephalexin
b. nitrofurantoin
c. trimethoprim
d. amoxicillin
e. Don’t give abx
A
Cephalexin
2
Q
- 36 wk gestation woman, baby growing on 3rd centile. Doppler is normal. What is the appropriate management for her pregnancy?
a. Await spontaneous delivery
b. Induce at 37
c. Induce at 39
d. Induce at 40
e. Immediate delivery
A
Induce at 37
3
Q
- Pregnant lady at 38+4. Chicken pox epidemic at younger child’s school. Patient confirms she has never had chickenpox in the past. She is currently well. Next step:
a. Check booking bloods for VZIG immunoglobulin
b. Ask to attend maternity assessment immediately
c. IVIG
d. Oral aciclovir
e. Reassure as she is past embryogenesis
A
Check booking bloods for VZIG immunoglobulin
4
Q
- Woman in labour w. 8:00am, 4cm; 12:00pm, 5cm, 16:00, 6cm With clear liquor from 4cm. Irregular contractions 3 in 10 minutes. What is the next step in management for this patient?
a. ARM
b. IV oxytocin
c. Vaginal prostaglandin
d. Vaginal sweep
e. Oral misoprostol
A
IV oxytocin
5
Q
- 80F has had itchy and sore vagina for 1-3 months? No bleeding or abnormal discharge. Pt has tried emolients, a moisturisers, oestradiol with no change. Photo shown (). What is Dx?
a. Vulval cancer
b. Vulval atrophy
c. Vulval candidiasis
d. Vulval sclerosis
e. Atrophic vaginitis
A
Vulval sclerosis
6
Q
- 36 weeks pregnant with right lower abdo pain. Fever. Nausea vomiting and reduced appetite. What is the best investigation based on the most likely differential?
a. MR scan of abdo
b. CT abdo scan
c. Laparotomy
d. Laparoscopy
e. Transvaginal US
A
MR scan of abdo
7
Q
Couple trying to get pregnant in 6-9 months, want non hormonal reliable contraception until then.
a. Cervical cap
b. Condoms
c. IUD
d. Family planning
e. Withdrawal method (lol)
A
IUD
8
Q
- Antiphospholipid syndrome management, trying to get pregnant. Three previous 1st term miscarriages. What should be taken?
a. Aspirin and LMWH
b. Prednisolone and aspirin
c. LMWH and vaginal progesterone
d. LMWH
e. Warfarin
A
Aspirin and LMWH
9
Q
- What is threshold for anaemia in a pregnant women of 19 wks gestation?
a. <115
b. <110
c. <105
d. <100
e. <95
A
<105
10
Q
- Woman first baby, 32 weeks, Baby along 8th centile with low liquor and normal doppler. Next scan?
a. 1 week
b. 2 weeks
c. 3 days
d. 3 weeks
e. 4 weeks
A
2 weeks
11
Q
- Woman with 2x2 cm mass that is inferolateral to the vaginal vestibule - red and hot to touch. She is apyrexial. Mx?
a. Incision and drainage
b. Marsupialisaton
c. IV abx
d. Biopsy?
e. Warm compress
A
Incision and drainage
12
Q
- 60F post-menopausal with raised Ca-125. Has imaging and found a multi-loculated unilateral cyst on ultrasound. No ascites or free fluid. What is most indicative of ovarian cancer?
a. Unilateral
b. Absence of free fluid
c. Multiloculated
d. Liquid cyst
e. >5cm
A
Multiloculated
13
Q
- Woman in early pregnancy with 15 mm amniotic sac and no foetal pole. what next
a. Expectant management
b. Surgical management
c. Misoprostol
d. Rescan in 2 weeks
e. Methotrexate
A
Rescan in 2 weeks
14
Q
- 50F has 5 children, previous HPV+ smear and BMI of 42. What will most increase ppl female risk of endometrial cancer?
a. Previous +ve HPV
b. Grand multiparity
c. Obesity
d. Family history of breast cancer
e. Hormone replacement therapy
A
Obesity
15
Q
- Female at 28 wk gestation, iuì2 previous LLETZ procedures, now has intermittent abdominal pain and increasing vaginal discharge. What is the likely complication of her procedures?
a. Chorioamnionitis
b. IUGR
c. Placental abruption
d. Preterm labour
A
Preterm labour
16
Q
- Woman with increased stinky discharge and pain. Pregnancy test negative. Most likely short term complication?
a. Tubo-ovarian abscess
b. Tubal damage
c. Subfertility
d. ?appendix rupture?
e. Ovarian torsion
A
Tubo-ovarian abscess
17
Q
- 36 year old female with 3yrs of painful, heavy periods every 4-6 weeks. Nulliparous, 34 BMI. Best treatment?
a. COCP
b. POP
c. IUS
d. Devo-provera
e. Implantable progesterone
A
IUS
18
Q
- Pregnant 41 yr old woman had previous DVT in pregnancy. When should she start LMWH?
a. 12 wks
b. 20wks
c. 24wks
d. 28wks
e. 32wks
A
12 wks
19
Q
- South Asian Lady is 36 years old has had an emergency C-section 4 days ago. She has had 2 other children. The patient now comes in with red and hot incision site. She has a BMI of 41kg/m2, had gestational diabetes during the pregnancy. Which of these factors increases infection risk the most?
a. Gestational diabetes
b. BMI 41
c. Age
d. Multiparity
e. Ethnicity
A
Gestational diabetes
20
Q
- Women has had C section 24h ago, took out catheter. She has since voided 90ml after 6 hours. What do you do first
a. Bladder scan
b. Encourage oral intake
c. Fluid balance chart
d. Catheter in out
e. Another catheter option
A
Bladder scan
21
Q
- 36 year-old-woman presents with very heavy periods lasting 3-5 days. She feels dizzy/faint. She has had 3 children. What is the first-line Ix for her bleeding?
a. FBC
b. TVUSS
c. Clotting studies?
A
FBC
22
Q
A 40+0 week pregant women has come in with spontaneous labour pains. Cervix feels hard and allows a fingertip to pass. What is the best management?
a. Mechanical dilation
b. Vaginal prostaglandins
c. IV oxytocin
d. Artificial rupture of membranes
A
Vaginal prostaglandins
Mechanical if she had a previous C section bc VBAC
23
Q
- 36 weeks. 6 hours of reduced foetal movements. Ctg normal. Foetal movements started again. Next step in management
a. discharge and safety net
b. admit for observation
c. arrange ultrasound scan
A
discharge and safety net
24
Q
- A 39-week pregnant woman is in sponatneous labour. Her previous child was treated for GBS on day 2 of life. What is the management for her current pregnancy?
a. IV clindamycin
b. No treatment
c. Vaginal wash
d. IV penicillin
A
IV penicillin
25
A primip in her 30s is complaining of pain in her lower back and pelvis. The pain is worse when climbing stairs and bending down. What is the appropriate management?
a. Ibuprofen
b. Codeine
c. Referral to physiotherapy
d. Epidural
e. Referral for maternity /midwife assessment
Referral to physiotherapy
26
26. A woman in her 60s with a few months history of incontinence. She feels like she wets herself suddenly without warning. No leakage when sneezing or coughing. What is first line treatment?
a. Bladder retraining
b. Duloxetine
c. Tolterodine
d. Pelvic floor exercises
Bladder retraining
27
1. From what period, should delivery for a woman with dichorionic diamniotic twins be offered? Give an answer in X weeks
37 weeks
28
2. Lady is in her 3rd trimester and presents with itchy palms. What test would give you the most likely diagnosis?
Bile acids
29
3. 32 year old woman has a sexual health screen. She is asymptomatic. Results shown below:
Hep B: Negative
Syphilis: Negative
Endocervical: Negative
NAAT (gonorrhoea, chlamydia): Negative
Wet mount: jerky motility seen
What is the most appropriate management?
Metronidazole
30
4. Lady has N+V of pregnancy at 10 weeks. This is second attendance to A&E for N&V. She was given an anti-emetic prescription for the last 3 days or 3hrs?, now she has face twitching and muscle spasms. What was she prescribed?
Metoclopramide
31
5. Pregnant woman with Ehler-Danlos Syndrome has back pain and pelvic pain, made worse on walking up stairs and turning on bed, not relieved by paracetamol. Dx?
symphysis pubis dysfunction
32
6. 32 weeks gestation women having check-up. BP is 145/90. What is next Ix?
Urine dipstick
33
7. Woman during labour, unbearable abdo pain, with pain that radiates to shoulder tip with each contraction and vaginal bleeding spotting. Previous Caesarian section. Contractions become more frequent. Fetus has pathological trace and mother suddenly collapses. What is the most likely diagnosis?
Uterine rupture
34
8. Headache 3 days after C section. Better when lying down. What is the dx?
Post-dural tap headache
35
9. 49F has IUS for contraception. She wants to start hormonal replacement therapy, but has a background hx of VTE. What is the treatment option that will increase thrombolysis risk the least?
Transdermal oestrogen
36
10. 30ish F with 2 weeks of fever, lower abdominal pain, and offensive discharge. What is the most likely diagnosis?
PID
37
11. Woman who is 10 weeks pregnant has hyperemesis. TVUSS reveals no fetus but intratuerine cystic mass? What is the most likely diagnosis?
Molar pregnancy
38
12. Woman has seizure 2 hours post partum. What medication do you give her to stop the seizure?
Magnesium sulphate
39
13. 40F presents with intermenstrual bleeding. On vaginal examination she has an anteverted uterus. TVUSS shows an endometrial thickness of 3mm, and a polyp on her uterine fundus measuring 8mm x 12mm with a vascular supply. What is the definitive management?
Hysteroscopic polypectomy
40
14. 25F Female had spotting for last 3 days. LMP 8 weeks ago. On USS uterine tissue seen 15mm sac, but no fetal pole. What is the correct classification of this?
intrauterine pregnancy of uncertain viability
41
15. Gold standard diagnostic investigation for suspected endometriosis?
Diagnostic laparoscopy
42
16. Female is 9 weeks pregnant and wants TOP. Has taken Mifepristone at clinic. What is next medication?
Misoprostol
43
17. Woman at 41+0 weeks and has come in for induction of labour. She does not have any contractions, and on vaginal exam, her cervix is 2cm, soft, posterior and admits a finger. What should be the first step in inducing her labour?
Vaginal prostaglandins
44
18. Description of rash in pregnancy, started on abdomen and was itchy, pretty sure it was 3rd trimester, specifically stated papular rash? LFTs given and were normal.
Polymorphic eruption of pregnancy
45
19. Degree of perineal tear. Involving the anal sphincter complex but not the anal mucosa
Grade 3
46
1. 3 year old with LUQ mass and abdo pain for a few weeks and BP130, but is well otherwise. What investigation is most discriminatory?
a. Urine dip
b. FBC
c. Blood film
d. Urinary catecholamines
e. Ebstein Barr virus serology
Urinary catecholamines - neuroblastoma
47
2. 15yo feels tired, itchy rash, picture shown (its the same one each year), what do you prescribe?
a. Topical antibiotics, review in 2 wks
b. One week trial oral antibiotics review in 1 wk
c. One week trial oral antiviral review in 1 wk
d. Immediate referral to paediatricians
e. Topical emollient and routine dermatology review
Immediate referral to paediatricians (eczema herpecticum)
48
3. 13 month child who can stand and walk whilst holding onto surfaces. Can hold a cup but not use a spoon. Cannot stack blocks but could clap and wave goodbye. They know 5-10 words, but cannot put two words together. Which one of the following accurately describes this child?
a. Language delay with no motor delay
b. Gross motor delay but no fine motor delay
c. Fine motor delay but no gross motor delay
d. Normal development
e. Speech delay
f. Social delay
Normal development
49
4. 2 year old who can go upstairs and run, but cannot hop on one leg. Knows 5-10 words but cannot join them. Can turn pages in a book but not one at a time. Can use a spoon but not a fork. Which one of the following accurately describes this child?
a. Fine motor delay
b. Cognitive impairment
c. Gross motor delay
d. Speech and language delay
e. Social delay
Speech and language delay
50
5. absence? (I can’t remember exact type) seizure at 2 years old, intellectual disability/developmental delay, when examining back you see the Picture shown to the left showing Shagreen patch, diagnosis?
a. NF1
b. NF2
c. Tuberous sclerosis
d. Sturge-Weber
Tuberous sclerosis (Shagreen patch)
51
6. 7 year old boy with asthma who comes to GP for asthma review. Mum thinks asthma has been well controlled. He is using salbutamol inhaler 3-4 times week, also on inhaled ICS using 2 puffs daily and daily montelukast. What is the most appropriate management of this patient?
a. Add salmeterol and keep the salbutamol
b. Advise inhaler technique
c. Oral prednisolone
d. Monitor peak flow for a month
e. Continue medications as is
Add salmeterol and keep the salbutamol
52
7. Child comes into A&E with acute shortness of breath, sats 90%, Wheezes throughout, Already given oxygen, what do you give them?
a. Salbutamol via inhaler and spacer
b. Salbutamol via nebuliser
c. Oral dexamethasone
d. IM adrenaline
e. IV aminophylline
b. Salbutamol via nebuliser
53
8. Child with vomiting after feed but happy to eat again soon after, not properly gaining weight, what is the definitive management, also showed ?ABG showing hypokalaemic hypochloraemic metabolic acidosis
a. Insufflation
b. Pyloromyotomy
c. Kasai procedure
d. Nissen fundoplcaton
e. Anorectal pull through
Pyloromyotomy
54
9. 5 days old Child with jaundice. 3.00kg newborn weight, now 2.80kg. On graph they are at phototherapy level - 370 at day 5; breastfeeding well currently what do you do?
a. Phototherapy
b. Phototherapy with feeding support
c. Exchange transfusion
d. IV feeds
Phototherapy
55
10. Kid with puffy eyes - hypoalbuminaemia on bloods and widespread oedema. What finding would be suggestive/supportive of diagnosis?
a. Proteinuria
b. Haematuria
Proteinuria
56
11. 11 year old with lethargy for the past 3 months. Bloods showing pancytopenia. PMHx of congenital radial hypoplasia, previously well. What is the most likely diagnosis?
a. Acquired aplastic anaemia
b. Fanconi anaemia
c. Acute lymphoblastic leukaemia
d. Parvovirus B19
Fanconi anaemia
57
12. 13 yr old boy with a lump under one nipple. Given growth chart which shows he is growing fine - 75th centile for height. 99th centile for weight. What is likely dx?
a. Benign cyst
b. Breast cancer
c. Pubertal gynaecomastia
d. Kleinfelters
Pubertal gynaecomastia
58
13. 17F with no secondary signs of puberty and has not started her period yet. No significant past medical history. What is the most likely diagnosis?
a. Klinefelter’s
b. Kallmann’s
c. MRKH syndrome
d. Turner’s syndrome
e. William’s syndrome
Turner’s syndrome
59
14. Child with SVT on ECG. Pulse 210bpm Child is pale and cool peripheries. Blood pressure is not able to be measured. What is management?
a. Amiodarone
b. DC synchronised
c. DC unsynchronised
d. Adenosine
e. Propranolol
DC synchronised
60
15. 14 year old girl has been taking 750mg paracetamol 4 times a day for the past 10 days for headaches. Now presenting to A&E with abdominal pain. Serum paracetamol level is 80mg/litre. She is 45 kilos. What is the most appropriate management? Below treatment line so no infusion?Displays signs of hepatic tenderness (staggered OD = NAC?)
a. Abdominal ultrasound
b. Refer to paediatrics
c. Refer to CAMHS
d. IV N-acetylcysteine infusion
e. Write a letter to GP
IV N-acetylcysteine infusion
61
3 year old Child with difficulty with swallowing. Puffy eyes. Reluctant to walk, crying when put to stand. Creatine kinase 600 (25-200), ESR 30 (<25)
a. Triple A syndrome
b. Juvenile dermatomysositis
c. IgA Nephropathy
d. Nephrotic
e. Nephritic
f. Perthes
Juvenile dermatomysositis
62
17. Kid at GP for normal 3-4mo old checkup. Found a constant 3/6 murmur best heard in left infraclavicular space. No change when change in posture. No cyanosis, no tachypnoea. No hepatomegaly. Bounding femoral pulses. What is dx?
a. Innocent murmur
b. Coartaction of the aorta
c. VSD
d. Patent ductus arteriosus
e. Patent foramen ovale
Patent ductus arteriosus
63
18. Kid with microcephaly, smoothness between nose and thin lip
a. Foetal alcohol syndrome
b. Turner’s syndrome
c. Down’s syndrome
d. Patau’s syndrome
e. Williams syndrome
Foetal alcohol syndrome
64
19. Kid presents to GP with barking cough and mild difficulty breathing. No intercostal indrawing. What is next management?
a. Oral dexamethasone
b. Admit to hospital
c. Reassure and safeguard
d. Nebulised adrenaline
e. Nebulised budenosine
Oral dexamethasone
65
20. 5 year old child has fevers, bloody diarrhoea, and lethargy. Their urine dip shows protein: nil, blood: +++, glucose: nil. Bloods are as follows:
Hb: 90 (109-150)
WCC: 16.7 (2-10)
Platelets: 15 (150-500)
a. HUS
b. Nephritic syndrome
c. HSP
d. ITP
e. TTP
HUS
66
21. 6M old baby has developed a rash after changing to bottle feed, what other kind of milk will you give him
a. Goat’s Milk
b. Lactose free milk
c. Extensively hydrolyzed milk
d. Soy milk
e. Camel’s milk
Extensively hydrolyzed milk
67
22. 8M with hip pain that has developed over the last 6 weeks, now is limping. O/E pain on internal rotation. Bilateral Hip x-ray shown.
Perthes
68
23. Child with prodrome of fever and flu like symptoms, develops a rash (photo shown) that spreads from the face (started behind the ears) + red spots in mouth, what is the diagnosis
a. Measles
b. Mumps
c. Eczema herpeticum
d. Kawasaki
Measles
69
24. 9 month old has 3 days of fever and one episode of vomiting. Also normal ?ENT exam. Normal obs. Ix?
a. Urine dipstick
b. Blood cultures
c. Urine culture
d. Chest X-ray
Urine dipstick
70
25. 14F comes to A&E with N&V accompanied by friend, thinks she might be pregnant. She is a cared for child. She then leaves before being seen. Dr cannot contact her with the mobile number listed. What should be done next?
a. Discuss her Gillick competency
b. Call duty social worker and police to bring her back
c. Urgent referral to social services
d. Call GP to have urgent appt with her
e. Refer her to antenatal clinic
Call duty social worker and police to bring her back
71
26. Kid with DKA. What is first treatment?
a. IV insulin
b. IV maintenance fluids
c. IV fluid bolus
d. IV sliding scale insulin
IV fluid bolus
72
27. Child who has been seizing for 5 mins, Buccal midazolam already given, cannula placed. what do you give next in ER?
a. IV phenytoin
b. IV Diazepam
c. IV lorazepam
d. IV levetiracetam
IV lorazepam
73
4M fell off climbing frame in park and has pain in hand and arm. This is the x-ray (below): What is next definitive Ix?
a. Bone profile
b. Vitamin D
c. Parathyroid levels
d. Calcium levels
Vitamin D
74
29. 8-week old girl in GP, absolutely fine. All examinations and obs were normal apart from a fever of 38.5oC.
a. Discharge with safety netting
b. Prescribe Abx
c. Urgent admission
Urgent admission
75
30. Child came in with 1 day history of sore throat, difficulty swallowing and fever. Bilaterally enlarged painful tonsils with exudate, cervical lymphadenopathy, fever etc.
a. Discharge with safety netting
b. Amoxicillin
c. Phenoxymethylpenicillin
d. Review in 48 hours
e. Admit to hospital
Phenoxymethylpenicillin
76
31. Asthma follow up at GP, mum has not attended follow ups or picked up inhalers and they’ve run out but daughter is well and they interacted well. What is the next step in management?
a. Discuss with on call paediatrician
b. Discuss with safeguarding lead at GP
c. Follow up in 1 month
d. Make her an appointment with outpatient respiratory clinic
Discuss with safeguarding lead at GP
77
3 week neonate vomiting, with slanting eyes and epicanthal folds
Duodenal atresia
78
2. Baby born at 28 weeks has SOB and high oxygen requirement and has respiratory distress syndrome. They are currently being managed on CPAP. CXR shows bilateral opacities. What is the next appropriate pharmacological mx?
intratracheal surfactant deficiency
79
3. Neonate born via vaginal delivery is on the ward with increasing respiratory distress. Its APGAR was 5, 7, 10 at 1, 5, and 10 minutes. A chest X-ray (this exact one) was taken and is shown. What is the most likely diagnosis?
Pneumothorax
80
Medical term for strawberry naevus?
Haemangioma
81
Medical term for chest indented
Pectus excavatum
82
6. Child with scarlet fever, given penV but fever persisted with no improvement in symptoms, strawberry red tongue (picture shown), throat swab shows no strep. What is the diagnosis.?
Kawasaki disease
83
7. Kid with yellow crusted rash around lips. What is the likely causative organism?
Staphylococcus aureus
84
8. What investigation should be done following recurrent UTIs of infants to check for complications?
DMSA scan
85
9. What is the pharmacological treatment for head lice?
Malathion
86
10. UTI with klebsiella and 2 year old. What is the GOLD STANDARD investigation you do in the acute phase?
Ultrasound urinary tract
87
11. 3 year old girl with sudden onset stridor and drooling. Temperature 37.1, RR 40, SpO2 98%. No other signs of respiratory distress. What is the most likely diagnosis?
Inhaled foreign body
88
12. 13 year old girl with recurrent left sided ear infections for 6 months. Photo shown. Multiple rounds of different antibiotics have not worked. What is the most appropriate management?
Surgical removal (cholesteatoma)
89
13. Kid with red cheeks (photo), fever and coryza. What is causative organism
Parvovirus B19
90
14. 13M child goes to birthday party. Gets urticaria and wheeze. What is the next management and how is it administered? IM adrenaline
IM adrenaline
91
15. 3 months old kid with coryza, fever. Oxygen saturations of 90%. Respiratory exam reveals widespread bilateral inspiratory fine crackles. What is it?
Bronchiolitis
92
16. 8 week old child with constant inspiratory sound for past few months. Worse when crying. Also sometimes has trouble eating. What is the most likely diagnosis?
Laryngomalacia
93
17. Baby with nappy rash for last 2 weeks. Photo below showing satellite lesions. Has tried barrier cream and break from nappies. What is the next treatment?
Clotrimazole
94
18. 11 year old girl with 6 weeks worsening headaches, tingling. She is struggling at school. Now is vomiting in the morning. What is the gold standard investigation for definitive diagnosis?
MRI head
95
19. Kid with joint pain, swollen ellbow, abdominal pain and purpuric rash. Dx?
Henoch-Schonlein purpura
96
20. Parents brought in 2-day-old for review after birth. Rash on face and trunk with small papules on erythematous base. Baby seems systemically well.
Erythema Toxicum
97
ausing long QT?
a. Escitalopram
b. Amlodipine
c. Venlafaxine
d. Antihypertensive
e. Aripiprazole
Escitalopram
98
2. 78yr old man in hospital distressed, agitated, paranoid and hallucinating? Cleared for delirium. ECG shows QT >500ms Which medication to use?
a. Haloperidol
b. Lorazepam
c. Aripirazole
d. Zopiclone
Lorazepam
99
3. 65 year old man works night shift as hospital administrator. He says his colleagues describe him as ‘a loner’, but not unfriendly. Close friends say he’s an eccentric man and is suspicious of others.
a. Schizoid (apparently wasnt an option)
b. Autism
c. Depression
d. Schizotypal
e. OCD
Schizotypal
100
4. Anorexic person - what would they have?
a. Irregular HR
b. Bradycardia
c. Hypertension
b. Bradycardia
101
5. Something about stopped alcohol and was abstinent but has intense cravings and wants to stay off alcohol. Previous NSTEMI. He also has ?heroin addiction and I think was taking buprenorphine for that lol. What do you give?
a. Acamprosate
b. Chlordiazepoxide
c. Naltrexone (makes alcohol less enjoyable)
d. Disulfiram
e. Varenicline
Acamprosate
102
6. Tingling, numbness from feet till thigh in a drug user for 3 weeks. Which drug is likely to cause it?
a. Heroin
b. Amphetamine
c. Nitric oxide
d. Cocaine
e. Marijuana
Nitric oxide
103
7. Patient with Crohn’s disease came in with 2kg weight loss, bloody diarrhoea, ESR/CRP raise and then was started on IV methylprednisolone. Hour later became agitated with hallucinations, not oriented to TPP, thought the nurse looked like a ghoul. Dx?
a. Delirium
b. Steroid-induced psychosis
Steroid-induced psychosis
104
8. Woman gave birth 6 weeks ago, got signs of depression starting 2 weeks ago. Close family friend also passed away 2 weeks ago. Most likely diagnosis?
a. Postnatal depression
b. Adjustment disorder
c. Baby blues
d. Recurrent depression
e. Uncomplicated bereavement
Uncomplicated bereavement
105
9. An international student had 3 days(?) of anxiety depression and difficulty sleeping since her grandma in Singapore passed away while she was taking an exam in the UK. Most likely diagnosis?
a. Acute stress reaction
b. Adjustment disorder
c. GAD
d. Panic disorder
Acute stress reaction
106
10. A man feels panic (flushing, palpitations) with meetings, especially when asked to present to the team. He is also concerned about what other people think of him. This doesn’t occur at any other time. Diagnosis
a. Agoraphobia
b. Social phobia
c. Panic attack
d. Anxious (avoidant)
Social phobia
107
11. Treatment resistant psychosis. Next step?
Clozapine
108
12. Women with OCD over bacteria. Has quit her job over it and just stays at home. What do you offer her ?
a. Exposure and response therapy
b. Exposure response + sertraline
c. Sertraline
d. CBT
b. Exposure response + sertraline
109
13. PAtient with recurrent abdominal pain, generalised weakness ?and other types of pain maybe? since mother died 1 year ago. Extensive investigations showed nothing.
a. Conversion
b. Somatisation
c. Hypochondria
d. Malingering
Somatisation
110
14. 20F Woman in A&E hears people talking about how she is a danger to national security. She says they are going to arrest her because of this and needs to protect herself, does not want to expand on this. Is agitated not aggressive, no PMHx or MHx Most appropriate next mx?
a. Call police
b. Refer to early intervention psychosis team
c. Refer to crisis resolution team
d. Refer to home treatment team
e. Refer to single point access
b. Refer to early intervention psychosis team
111
15. Woman comes to GP for a sexual health screening. She is wearing bright coloured clothing and talks about how she has quit her job as she is sure she will get the job as the CEO of some big successful company. She has a 2 year PMH of mild depression that was treated with antidepressants. Dx?
a. BPAD
b. Schizoaffective
c. Schizophrenia?
BPAD
112
16. Podcast talking about the patient
a. Delusion of reference
b. Delusional mood
Delusion of reference
113
17. Man comes in with concerns about vitamin deficiency, dental enamel thinning, also slight parotid swelling. He also reported spells of high anxiety with palpitations. BMI 24, ALL results were normal (FBC, U&Es, LFTs, TFTs, Vit D)
a. Bulimia
b. Cocaine abuse
c. Mumps
d. Lymphoma
Bulimia
114
18. Lawyer who has been missing breakfast (meals) a lot due to work and running a lot to manage stress. Secondary amenorrhea over last 6 months, obs and BMI normal.
a. Hypothyroidism
b. Anorexia nervosa
c. Bulimia nervosa
d. Depressive disorder
Anorexia nervosa
115
19. Referred to CAMHS because she struggles to focus & is disruptive in school and not organised, daydreams a lot, not doing well in any class except for in art where she hands in intricate work (something about school work in other classes markedly worsening over time). Fhx of “specific learning difficulties” (didn’t mention anything about behaviour outside of school)
a. Autism
b. Absence seizures
c. ADHD
d. Specific reading difficulty
ADHD
116
Child with fixed interests and gets upset when you have to go out of routine.
Autism spectrum disorder
117
22. 58-year-old man complains of low mood, anhedonia, poor sleep, poor appetite etc. Trialled on numerous different SSRIs, and has had CBT for 6 months which have not resolved his symptoms. He also has poorly-controlled hypertension. What would be the most suitable medication to give him?
a. Sertraline
b. Mirtazapine
c. Clomipramine
d. Venlafaxine
e. Zopiclone
Mirtazapine
118
20. Young male, few month history withdrawn from friends, started smoking cannabis in the past 3 weeks. Now has delusional symptoms, thinks the government is poisoning him?
a. Paranoid schizophrenia
b. Severe depression with psychotic features
c. Drug-induced psychosis
Paranoid schizophrenia
119
23. Kid who has trouble listening to people, behavioural difficulties at school and home, also self-injurious behaviour. Global developmental delay.
a. Learning difficulty
b. Depressive disorder
c. Conduct disorder
e. Oppositional defiant disorder
f. Emotional dysregulation
Learning difficulty
120
24. Alcohol detox question, tried 2 years ago and had a seizure
a. Prescribe decreasing chlordiazepoxide
b. Inpatient detoxification referral
c. Self help
Inpatient detoxification referral
121
25. A question on someone who was agitated, given an oral haloperidol to no avail what to use next
a. Oral diazepam
b. IM haloperidol
c. IM lorazepam
d. Oral zopiclone
e. Oral promethazine
IM haloperidol
122
26. Head injury. Changes to personality and behaviour, showing disinhibition. Speech is not as fluent anymore. Which lobe was damaged?
a. Temporal lobe
b. Occipital lobe
c. Frontal lobe
Frontal lobe
123
Thought disorder question - wasn’t answering question, but sentences had discernable links to one another.
Flight of ideas
124
27. Older man with memory issues, poor decision-making and recent decline in speech. Scan showed hippocampal changes? What is likely pathology.
a. Alzheimer’s disease
b. Vascular dementia
c. Dementia with Lewy Bodies
d. Delirium
Alzheimer’s disease
125
1. Patient seen in GP, with recent history of weight loss, controls what and how much he eats to avoid being fat, uses laxatives to help control his weight What is the best tool to assess risk?
MEED guidelines
126
2. Man on olanzapine, amitriptyline, sertraline, Hx of cocaine use. Sweating, HR ~110bpm?, BP 150/??, increased reflexes, tremor, sweating. Dx?
Serotonin syndrome
127
3. Lady is getting stressed and anxious about her job as librarian. She stays late to line up books on the shelves. Her colleagues call her a perfectionist but she says that they are not as conscientious about their work as she is. Dx?
OCPD/Anankastic
128
4. Type of delusional belief where a patient thinks they are rotting.
Cotard syndrome
129
5. Patient started on antipsychotic (2m ago?). Displays rigidity, tremor, and slow movement. Likely dx?
Drug-induced Parkinsonism
130
6. What legal framework for patient on AMU who wants to self-discharge from ward after failed suicide attempt - regrets that it failed and said he wants to try ?hang himself at home?
Mental Health Act Section 5(2)
131
7. Legal framework for delirium and agitated dementia patient who wants to leave hospital?
Mental Capacity Act - DoLS
132
8. Patient w. anorexia nervosa that comes in with Low mag, phos, and potassium. Dx?
Refeeding syndrome
133
9. 33M with heroin addiction. Suddenly stops taking heroin at addiction centre. What investigation must be done before starting medication?
LFTs
134
10. Person has chronic pain that is managed by pain team and another team. Recently started on fentanyl patch, RR is now 7, what would the ED doctor give?
Naloxone
135
11. 60 year old patient with low mood and poor sleep. Which medication best treats both symptoms?
Mirtazapine
136
12. 80M with increasing memory problems, planning problems. Wife reports that he is sometimes has episodes where he becomes confused (TIA?). 30 pack year hx, T2DM, and obese. (Strong step decline hinted at) Dx?
Vascular dementia
137
13. Old man sees little animals running around. Memory not formally assessed, but signs of memory deterioration.
Lewy Body dementia
138
14. Person who sounded like they had EUPD (variable mood, impulsive self-harm). Previously had CBT and another psychoanalytic therapy. What is next line of psychological treatment?
Dialectical behavioural therapy
139
15. Man with Alzheimer’s, with persecutory delusions and visual hallucinations. He’s currently on memantine.
atypical antipsychotics
140
16. BPAD man comes back from Spain with tremor, he’s on lithium. A million results. What’s the most important blood test (wasn’t Q more like what’s another important blood test to do, not most)?
Lithium levels
141
17. ECG sign of patient on antipsychotics
QT prolongation
142
18. Patient with an oculogyric crisis, what is the most appropriate pharmacological therapy?
Procyclidine
143
19. 20 year old started on an SSRI for depression, suicidal thoughts but no plans. What timeframe do you want to do your first follow up?
1 week
