Written Flashcards
(666 cards)
1
Q
When is the active phase of the first stage of labour considered to be abnormal?
A
Cervical dilatation of less than 2cm in 4 hours
2
Q
How should the active stage of labour be managed?
A
10iU oxytocin with the birth of the anterior shoulder
3
Q
How often should foetal HR be checked if there are no indications for continuous CTG?
A
15 minutes
4
Q
How often should frequency of contractions be checked in labour?
A
Every 30 minutes
5
Q
How often should maternal HR be checked in labour?
A
Every hour
6
Q
How often should maternal BP & temperature be checked, and how often should a vaginal exam be performed in labour?
A
4 hours
7
Q
How long after birth should maternal obs be checked?
A
2 hours
8
Q
When should APGAR score be checked?
A
1, 5, 10 mins post birth
9
Q
When should breastfeeding be initiated?
A
Within the 1st hour after birth
10
Q
When should vitamin K be administered to a newborn?
A
In the delivery room
11
Q
When should vaginal progesterone be used to prevent preterm labour?
A
16-24wks
If Hx spontaneous preterm birth
If Hx mid trimester loss
If cervical length <25mm on TV USS
12
Q
How is preterm labour managed?
A
Maternal Corticosteroids
Tocolytics (Nifedipine, Atosiban)
IV Magnesium Sulphate
13
Q
What is the antidote for magnesium sulphate toxicity?
A
Calcium Gluconate
14
Q
How is P-PROM managed?
A
Speculum
Erythromycin
Betamethasone
Magnesium Sulphate
15
Q
How is PROM managed with clear amniotic fluid?
A
Admit, 24h foetal surveillance
Offer IOL after 24h
16
Q
How long should you monitor a neonate for signs of infection after delivery with PROM?
A
12 hours
17
Q
How is shoulder Dystocia managed?
A
Call for help Mcrobert's Manoeuvre with suprapubic pressure Episiotomy Rubin II Wood's Screw Deliver posterior arm
18
Q
What is the risk of delivering the posterior arm in shoulder dystocia?
A
Humeral fractures
19
Q
How is breech managed?
A
ECV at 36 if P0, 37 if PX
If declined, CS/breech delivery
20
Q
How would you manage delivery if the baby is in the mento-posterior position (chin posterior)?
A
C Section
21
Q
What is the main risk of vaginal prostaglandins in induction of labour?
A
Uterine Hyperstimulation
22
Q
What is the main risk of artificial rupture of membranes?
A
Umbilical Cord Prolapse
23
Q
How would you induce labour in a woman with a bishop’s score of more than 6?
A
Amniotomy
24
Q
How would you induce labour in a woman with a bishop’s score of 6 or less?
A
Vaginal Prostaglandin if no Hx of hyperstimulation
Balloon catheter otherwise
25
How should you proceed if 2 hours after amniotomy labour has not begun?
IV Syntocinon
26
How should you proceed if umbilical cord prolapse is suspected?
Call for help
Continuous CTG
Theatre for immediate delivery
Elevate presenting part, reposition mother to all fours
27
How does PPH prophylaxis differ in C Section vs Vaginal delivery?
Vaginal -> IM oxytocin
| CS -> IV Oxytocin
28
How should chronic hypertension be managed in pregnancy?
Labetalol -> Nifedipine
Aspirin from 12wks to birth
Growth scans every 4 weeks
29
How often should diabetics monitor glucose during pregnancy?
7x a day
30
How is thyrotoxicosis managed in the postpartum period?
Propranolol
31
Which drug should be avoided in the intrapartum period in asthmatics and those with heart disease?
Ergometrine
32
What is the second line treatment for UTI in pregnant women?
Amoxicillin
| Cefalexin
33
How is toxoplasmosis treated in a pregnant woman?
Spiramycin
34
Which drug may be used to treat pregnant women with a high viral load of hepatitis B?
Tenofovir
35
How are neonates treated when mum had hep B?
Hep B Ig and Hep B vaccine given within 24h
36
What is the third line treatment for gestational hypertension?
Methyldopa
37
How should methyldopa use be managed in the postpartum period?
Stopped within 2 days of birth
38
How long after resolution should someone take a pregnancy test to see if their miscarriage is complete?
3 Weeks
39
What is the first line option for medical management of miscarriage?
Vaginal Misoprostol
40
What is the first line option for medical management of an ectopic?
Methotrexate
41
How would you follow up after salpingotomy for ectopic?
serum hCG every week until negative
42
How would you follow up after salpingectomy for ectopic?
Pregnancy test after 3 weeks
43
What is the first line management for molar pregnancies?
Suction curettage
44
For how long after sex can Ulipristal be used as emergency contraception?
120 hours
45
For how long can Levonorgestrel be used as emergency contraception after upsi?
72 hours
46
What is the recommended form of emergency contraception for women with a bmi >26?
EllaOne (Ulipristal)
47
Missed 2 coc pills in week 1?
Take 2 pills
Use condoms for 7 days
Emergency contraception
48
Missed 2 coc pills in week 2?
Take 2 pills
Use condoms for 7 days
No need for emergency contraception
49
Missed 2 coc pills in week 3?
2 Pills
Use condoms for 7 days
Finish current pack and omit pill-free break
50
How long should you use condoms if starting POP in the first 5 days of your cycle?
No need, immediate protection
51
How should cleft palates be managed surgically?
Primary lip closure at 3m
| Primary closure at 6-12m
52
How should a neonate with cmv be managed?
Barrier nursing
| Valganciclovir
53
How should neonatal conjunctivitis be managed?
Same day referral to Opthalmologist
| Chloramphenicol eye drops if mild
54
What might 10% of children with Down Syndrome display on FBC?
Transient Abnormal Myelopoiesis
55
How is neonatal GBS managed?
Penicillin (Benpen if csf +ve)
| Gentamicin
56
When is exchange transfusion indicated in a neonate?
Rapidly rising bilirubin despite phototherapy
| Significant anaemia <100
57
How is NEC managed?
Stop feeding
NG Tube
Cefotaxime and Vancomycin
Surgery if failure to respond
58
When is IV dextrose indicated in a neonate?
<1.5
| Symptomatic
59
How is persistent pulmonary hypertension of the newborn managed?
Maintain High kPa
Intubate
High-frequency oscillatory ventilation
Inhaled Nitric acid if demand remains high
60
How is Hyaline membrane disease managed?
```
ABC
Resp Support
Fluids
IV Abx
CXR
```
61
How is sudden infant death syndrome prevented?
```
Sleep on back
No Overheating
Feet to foot
No smoking
Parent's room for 6m
Don't sleep w baby in same bed
Breastfed
```
62
How is toxoplasmosis treated in the newborn?
Pyrimethamine
Sulfadiazine
Folinic Acid
63
How is tracheoesophageal fistula managed?
Surgery
64
When should antibiotics be used in management of transient tachypnoea of the newborn?
Persistent tachypnoea after 4-6h
65
How is paediatric aortic stenosis managed?
Balloon Valvulotomy
| Transcatheter Aortic Valve Replacement if severe
66
When is paediatric ASD treated?
Pulmonary to Systemic Blood Flow ratio >1.5
| If symptomatic
67
How is paediatric ASD treated?
Transcatheter closure
| Open heart surgery
68
How is the hyperoxia test carried out?
10 minutes 100% oxygen
| If sats remain low = likely congenital cyanotic heart disease
69
What may be used to close a PDA if medical management fails?
Surgical Ligation
| Percutaneous catheter
70
How is acute rheumatic fever treated?
High dose aspirin
| Benzathine Benzylpenicillin if signs of persistent infection
71
How is TOF managed?
Prostaglandin E1
Blalock-Taussig Shunt
Surgery after 4 months
72
How is transposition of the great arteries managed?
Prostaglandin E1
| Balloon Atrial Septostomy
73
What is a Blalock-Taussig Shunt?
Maintains shunt between subclavian and pulmonary arteries
74
What can be used to stop fainting when warning signs appear?
Physical counter-pressure manoeuvres and tilt training
75
How are VSDs managed?
Observation
Prophylactic Amoxicillin
Surgical repair if large (3-6m)
76
When should antibiotics be used in acute otitis media?
Amoxicillin if systemically unwell or rapid deterioration
77
Which Abx are indicated in Acute Epiglottitis?
Ceftriaxone
| Rifampicin prophylaxis to close contacts
78
How is rapidly developing angioedema managed?
Chlorphenamine
| Hydrocortisone
79
How should asthma be managed in a 5-16yo if an LTRA is ineffective?
Stop LTRA, add LABA
No? Switch to a MART regime
No? Increase to Moderate ICS
No? Seek advice (maybe high dose/theophylline)
80
How is a severe asthma attack defined?
```
33-50%
Can't complete sentences
Sats less than 92
HR > 125
RR > 30
Accessory Muscle use
```
81
How is a life-threatening asthma attack defined?
```
<33% PEFR
Sats less than 92%
Altered consciousness
Exhaustion
Silent Chest
Hyptoension
Cyanosis
```
82
How is a life threatening asthma attack managed?
```
Admit
Oxygen aim 94-98%
Nebulised Salbutamol
Nebulised Ipratropium
Nebulised Magnesium Sulphate
Prednisolone
```
83
Which screening should be done in a child with bronchiectasis?
Sweat test
| Antibody Deficiency
84
How should children with bronchiectasis be managed?
Strep & Flu vaccines
| Empirical antibiotics in acute exacerbation
85
Name an antiviral which may be used in paediatric COVID 19?
Remdesivir
86
How should severe croup be managed?
Oral Dexamethasone
Oxygen
Nebulised Adrenaline
87
What is the first line mucoactive agent used for prophylaxis in CF?
rhDNase
88
What is the second line mucoactive agent used for prophylaxis in CF?
Hypertonic sodium chloride
89
What is the third line mucoactive agent used for prophylaxis in CF?
mannitol dry powder
90
What should be used to treat chronic infection in a patient with cystic fibrosis?
Colistimethate sodium
| Tobramycin
91
What should be used to treat intestinal obstruction in CF?
Gastrograffin (diatrizote)
92
How is foreign body inhalation managed?
Cough
Back Blow/Heimlich
Flexible/Rigid Bronchoscopy
Surgery
93
How is diptheria managed?
Isolate
| BenPen
94
How is laryngitis managed?
Cefalozin
| Cefalexin
95
Which antibiotic is used for Scarlet Fever?
Phenoxymethylpenicillin (Pen V)
96
How would you determine if a child needs antibiotics for tonsilitis?
```
CENTOR score 3 or 4
Fever
Exudate
No cough
LAD
3-14years
```
97
How is viral episodic wheeze managed?
Burst Therapy salbutamol
| 10 puffs using high volume spacer, every 30-60s do a puff
98
What regimen would you give to a child in need of fluid resuscitation?
0.9% NaCl 20ml/kg in less than 10 mins
99
How is dehydration corrected in children?
% dehydration x kg x 10
100
What are routine maintenance fluids for children?
100ml/kg 0-10kg
50ml/kg 10-20kg
20ml/kg over 20kg
Over 24h
101
How are formula fed children with GORD managed?
```
Smaller feeds
Thick formula
Alginate
PPI
Refer
```
102
How are paediatric inguinal hernias managed?
Reducible? Manual reduction & elective surgery
| Non-Reducible? Emergency manual reduction and repair after 48h
103
How are paediatric umbilical hernias managed?
small? observe until 4-5
| Large? Elective repair at 2-3
104
How is Hirchsprung's managed?
Bowel irrigation
| Anorectal pull through
105
Which strategies might be used to calm a crying infant?
Holding
Gentle Motion
White Noise
Warm bath
106
How is intussusception managed?
```
IV Fluids NG Tube
Rectal air insufflation
Contrast enema
Clindamycin, Gentamicin
Surgery
```
107
How is malrotation managed?
Ladd procedure
| Cefazolin
108
How is pyloric stenosis managed?
Ramstedt Pyloromyotomy after electrolyte correction
109
How is volvulus managed?
Ladd Procedure
110
How is biliary atresia managed?
Kasai Hepatopotoenterostomy
111
How is localised impetigo managed?
Hydrogen peroxide
112
How is widespread impetigo managed?
Topical Fusidic Acid -> Oral Fluclox
113
How would you manage a patient with Acne Vulgaris that hasn't responded to 2 courses of antibiotics and is scarring?
Refer for consideration for Isotretinoin
114
How is eczema managed?
Emollient -> Steroid
115
How is erysepilas managed?
Pen V
116
What is the first line management for guttate psoriasis?
Phototherapy
117
How are haemangiomas causing functional impairment managed?
Beta Blocker
Steroid
Surgery if severe and unresponsive
118
How would you manage candida nappy rash?
Topical Imidazole
119
Name one treatment which may be used in the management of Pediculosis.
Dimeticone lotion
120
How is scabies managed?
Topical Permethrin
121
How is TTP managed?
Plasmapheresis
122
For how long is a congenital hydrocoele considered normal?
2 years
123
What must be present for a boy to undergo surgery after 3m for hypospadias repair?
Foreskin
124
What is the aim of hypospadias repair?
Straight Erection
| Straight urination
125
How is Paraphimosis managed?
Surgery, unless acute and not necrotic -> manipulation/puncture therapy
126
How is retinoblastoma treated in a patient with gross vitreous seeding present?
Enucleation
127
What may happen if you use desmopressin in children under 1?
Hyponatraemia and Seizures
128
Name one x ray finding in SUFE.
Trethowan's Sign
129
When should you offer medication to a child with ADHD?
Specialist advice after support groups fail.
130
How would you manage paediatric absence seizures?
Ethosuximide
131
How would you manage paediatric tonic-clonic seizures?
Sodium Valproate
132
How can you manage migraine in under 18s?
Nasal triptans
133
How is status epilepticus managed?
ABCDE
IV Lorazepam/ Buccal Midazolam/Rectal Diazepam
Second dose
Phenytoin
Induce anaesthesia with thiopental sodium
134
How is West Syndrome managed?
Corticosteroids
135
How long should it take to replace fluid in DKA?
48 hours
136
How is myopia managed?
Concave lenses
137
How is hypermetropia managed?
Convex lenses
138
How might gonadotrophin dependent precocious puberty be managed?
```
GnRH Agonist (Leuprolide)
GH Therapy
```
139
How is congenital adrenal hyperplasia managed?
Life long glucocorticoids
| Mineralocorticoids if salt losing
140
What are the main risk factors for miscarriage?
```
Increasing Age
Hx
Chronic Disease
Uterine Abnormalities (Including cone biopsies)
Smoking/Drug use
Weight
Invasive prenatal testing
```
141
When can a child with scarlet fever return to school?
24h after commencing antibiotics
142
Why is trace glycosuria common in pregnancy?
Increased GFR
| Reduction in tubular reabsorption of filtered glucose
143
When should you investigate glycosuria further in pregnancy?
1+ 2 or more times
| 2+ once
144
Which contraceptive is associated with weight gain?
Injectable Progesterone (Depo-Provera)
145
For how long after TOP might a pregnancy test remain positive?
4 weeks
146
Why should you avoid aspirin when breastfeeding?
Risk of Reye Syndrome
147
What is the school exclusion advice for hand, foot and mouth disease?
No exclusion required
148
When do infants begin to parallel play?
2 years (Two parallel lines)
149
How would you confirm menopause/premature ovarian failure?
Raised FSH
150
Which drug might be used as a deterrent to alcohol use by making it so you violently throw up on consumption?
Disulfiram
151
Which drug might be used to stop alcohol cravings?
Acamprosate
152
Which drug, taken sublingually, provides an alternative opiate replacement therapy to methadone?
Buprenorphine
153
At what age can a child hop on one leg?
3-4y
154
At what age can a child pull to standing
8-10m
155
At what age can a child squat?
18m
156
What is the second line therapy for viral-induced wheeze?
Oral Montelukast or Inhaled corticosteroids
157
What is required for an instrumental delivery to be considered?
```
FORCEPS
Fully dilated cervix
OA position
Ruptured membranes
Cephalic
Engaged presenting part
Pain Relief
Sphincter (bladder) empty
```
158
When is the presenting part considered engaged?
At or below the ischial spines
159
How is SUFE managed?
Referall to orthopaedics for in situ fixation with a cannulated screw
160
How is COCP use managed pre and peri-operatively?
Stopped 4 weeks before
Use POP
Restart after mobilisation
161
What is the triad of results seen on FBC that may indicate ALL in a child?
Neutropaenia
Anaemia
Thrombocytopaenia
162
What is the algorithm for newborn resuscitation?
Dry the baby and start the clock
Assess tone, breathing and HR
5 inflation breaths
If not adequate, start chest compressions at 3:1 ratio
163
When is CVS done?
11-13+6 weeks
164
When is amniocentesis done?
Week 15+
165
What is the risk of miscarriage in CVS?
1-2%
166
What is the risk of miscarriage in Amniocentesis?
0.5-1%
167
How should you proceed if a child younger than 3m old presents with a suspected UTI in GP?
Refer for immediate assessment in secondary care
168
Which side effects are common with Ipramine?
Dry Mouth
| Blurred Vision
169
A child presents with a multiloculated, hetereogenous cyst above the hyoid bone. What is the most likely diagnosis?
Dermoid Cyst
170
A child presents with a soft, transilluminate cyst in the posterior triangle of the neck. What is the most likely diagnosis?
Cystic Hygroma
171
A child presents with a lateral neck cyst which is smooth, fluid filled and has an anechoic appearance on ultrasound. What is the likely diagnosis?
Branchial Cyst
172
Which location for an ectopic pregnancy carries the highest risk of rupture?
Isthmus
173
Can bilirubin be measured transcutaneously in the first day of life?
No
174
What is checked at a booking appointment?
```
BP
Urine Culture
BMI
Hep B, HIV, Syphylis
Rhesus
Group and Save
```
175
What causes primary amenorrhoea in Turner's Syndrome?
Gonadal Dysgenesis = high FSH/LH
176
What are the signs of meconium aspiration syndrome on CXR?
Atelectasis
| Patchy Infiltrations
177
What is the triad for shaken baby syndrome?
Subdural Haematoma
Retinal Haemorrhages
Encepalopathy
178
How should secondary dysmenorrhoea be managed in the first instance in primary care?
Referral to gynaecology
179
Name one complication of SSRI use in the third trimester.
Persistent Pulmonary Hypertension of the Newborn
180
What is the typical prodrome of measles?
Cough, Coryza, Conjunctivitis, cKoplik White Spots
181
What effect may smoking cessation have on clozapine levels?
Increase
182
What happens if two COCP pills are missed in the second week of the cycle and the patient has unprotected sex?
No emergency contraception needed as long as first week taken properly
183
Which form of HRT can be used in a patient with migraine with aura?
Combined -> not contraindicated like COCP
| Topical > Oral
184
Name one absolute contraindication to HRT
Unexplained Vaginal Bleeding
185
Which scoring test is used to screen for depression?
PHQ-9
186
What is the key feature of Schizotypal Personality Disorder?
'Magical Thinking', Obsession with the paranormal
| Odd tone to speech
187
When can an IUS be used for contraception/ menorrhagia in the presence of fibroids?
Less than 3cm
| Not distorting the Uterine Cavity
188
How is Whooping Cough managed?
Oral Clarithromycin/Azithromycin if within 21 days of onset of cough
189
When is a radical trachelectomy indicated?
1A2 cervical tumours when the patient wants fertility preserved
190
Which tests make up the quadruple assessment?
Total hCG
Unconjugated Oestradiol
AFP
Inhibin A
191
What is the downside for the quadruple test vs the combined test?
4% false positive vs 2%
192
How might you treat a pregnant woman with breast cancer in the second/third trimesters?
Chemotherapy
Radiotherapy only if lifesaving
Not Tamoxifen
193
Which term describes firm placental adhesion without extending through the full myometrium?
Placental Accreta
194
Which term describes firm adhesion of the placenta which extends through the myometrium?
Placental Increta
195
Which term describes firm adhesion of the placenta with extends through the full myometrium and beyond?
Placental Percreta
196
What are the risk factors for Placental adhesion disorders?
Asherman's Syndrome
| Uterine Scarring
197
At what gestation is the earliest you should consider giving steroids for lung maturation?
24 Weeks
198
How would you investigate a potential PE in a pregnant woman?
V/P scan > CTPA
199
What happens to stroke volume in pregnancy?
Increases
| 30% higher by third trimester
200
What causes anaemia in pregnancy?
Haemodilution by increased plasma volume
201
What is the failure rate of female sterilisation?
1 in 200
202
When is warfarin contraindicated in pregnancy?
Third Trimester
203
Which drug should be offered to treat PE in pregnancy?
Enoxaparin
204
How does Vasa Praevia typically present?
Painless bleed at the time of rupture of membranes with subsequent foetal compromise
205
How should you manage a patient found to be in in eclampsia acutely?
ABCDE
Left lateral tilt
Protect Airway
Prepare Magnesium
206
What are the main complications of Obstetric Cholestasis?
Stillbirth
Preterm Labour
Meconium stained liquor
207
How do you deal with potential chorioamnionitis pre-24 weeks?
```
Antibiotics
Induce labour (unviable)
```
208
Are pre-eclampsia, small for age, a scarred uterus and oligohydramnios complete contraindications to ECV?
No, only relative
209
How do you manage T1 diabetes post delivery, if the patient was put on a sliding scale during pregnancy?
Return to pre-pregnancy meds once eating and drinking
210
What risks does SLE bring to a pregnancy?
```
Miscarriage
Foetal Death
Pre-eclampsia
Preterm Delivery
Foetal growth Restriction
```
211
What does a patient have if they present, pregnant, with a maculopapular rash, starting as stretch marks before spreading, but with peri-umbilical sparing?
Pruritic urticarial papules and plaques of pregnancy (PUPP)
212
A pregnant lady presents with blisters that started in the umbilicus and spread. What is the likely diagnosis?
Pemphigoid Gestationis
213
What is the range for protein-creatinine ratio in pregnancy?
<30
| Higher may indicate pre-eclampsia when joined by hypertension
214
How would you manage a patient who wants a TOP, is haemodynamically stable and has a suspected pseudocyst seen on transvaginal Ultrasound?
B-HCG 48h apart. >67% rise indicates viable intrauterine pregnancy and so can have TOP. Suboptimal rise = likely ectopic
215
What effect does PCOS have on risk of ovarian and breast cancer?
No increased risk
216
What is the main role of progesterone?
Enhance endometrial receptivity
217
What are the main roles of oestrogen?
Stimulate endometrial growth
Increase fat deposition
Increase Bone resorption
Stimulate uterine growth
218
What is the first line treatment for heavy menstrual bleeding?
IUS
219
Which analgesia would you use during labour if the patient is failing to progress and the baby is unlikely to be born for a while?
Epidural
220
What defines a pathological ctg trace?
2 non-reassuring features
| 1 pathological feature
221
What are the non-reassuring ctg features?
160-180/100-109 bpm
<5bpm variability for 40-90min
Absent accelerations, otherwise normal trace
Variable decelerations/Single prolonged less than 3 mins
222
What are the pathological ctg features?
>180/<100bpm
<5beats variability for 90min
Atypical variable decelerations over 50% contractions/late decelerations for over 30min
Single prolonged deceleration >3min
223
When must you not give an epidural to a woman in labour?
Hypotensive
Allergies
Systemic infection/infection over epidural site
Bleeding disorders
224
A woman presents 48 hours after delivery with SOB, tachypnoea and signs of congestive heart failure. CXR shows pulmonary oedema and cardiomegaly. What is the most likely diagnosis?
Postpartum Cardiomyopathy
225
A newborn presents with hydrocephalus, and chorioretinitis. They are observed to be microcephalic. What is the likely cause?
Toxoplasmosis gondii
226
How are bartholin's abscesses treated?
Marsupialisation: Surgery where the abscess is opened and the lining sutured open, so the gland doesn't later become blocked again
227
Which cancer does the COCP protect against?
Ovarian
228
How would you identify a vesico-vaginal fistula?
Pass a a catheter and fill the bladder with methylene blue dye.
Perform speculum to see if dye is in the vagina
229
What is Meig's Syndrome
Right sided pleural effusion associated with an ovarian fibroma
230
How is Risk of Malignancy Score calculated?
```
One point per ultrasound feature = U
U x CA-125 (x3 if post-meonopausal)
>250 = 75% cancer
50-250 = 20% cancer
<50 = 3% cancer
```
231
Which form of hormonal contraception can be used in patients also taking enzyme-inducing drugs?
Depo-provera
232
Name 4 potential complications of chickenpox.
Disseminated haemorrhagic chickenpox
Secondary Bacterial Infection
Encephalitis
Pneumonia
233
What are the poor prognostic factors for ALL?
<2yo >10yo
B/T Cell surface markers
WCC >20*10^9/l
234
Which contraceptive method shouldn't be used over the age of 50, and why?
Injectable, increases risk of osteoproosis
235
What proportion of patients with hypospadias also have cryptochordism?
10%
236
What is the algorithm for management of PPH?
```
Uterine Compression
IV syntocinon
Ergometrine ( X HTN)
Syntocinon
Carboprost
Misoprostol (X Asthma)
```
237
How is Phimosis managed?
<2yo normal, reassure
238
What is the first line surgical management for uterine atony?
Itrauterine Balloon Tamponade
239
Which type of incontinence is associated with tricyclic antidepressants?
Overflow
240
Which medication is used from 12-14 weeks to prevent pre-eclampsia in high risk individuals?
Low dose aspirin
241
How long after taking Ulipristal Acetate should you wait before restarting hormonal contraception?
5 days
242
Which pulse abnormality is associated with PDA?
Collapsing Pulse
243
Which bacteria causes necrotising fasciitis derived from chickenpox lesions?
GAS
244
Which medications used for neuropathic pain might cause urinary retention?
Tricyclic Antidepressants
245
Which emergency contraception is most effective in those with high BMIs?
Copper Coil
246
Which screening test is used for post-natal depression?
Edinburgh Scale
247
What are the core symptoms of depression?
Anhedonia
Anergia
Low Mood
248
What is the first line treatment for primary dysmenorrhoea?
NSAIDS (Mefenamic Acid)
249
What is the first line non-hormonal management for menorrhagia?
Tranexamic Acid
250
How would you medically manage abortion?
Oral Mifepristone
| Vaginal Prostaglandin
251
What UKMEC risk level are anti-phospholipid antibodies with regards to the COCP?
4 - Unacceptable risk
252
Which type of amnesia more commonly occurs due to ECT?
Retrograde, remembering events before the procedure
253
A teenager presents with intermittent locking of their left knee with pain after jogging. What is the likely diagnosis?
Osteochondritis Dissicans
254
Which conditions not usually seen in females might present in those with Turner's Syndrome?
X-Linked Disorders, due to the XO genotype
255
Which conditions are associated with neonatal hypotonia?
Prader-Willi
Hypothyroidism
Spinal Muscular Atrophy
Neonatal Sepsis
256
When should a small umbilical hernia be referred for surgical repair?
5yo
257
If 2 COCP pills are missed in week 1, what would you do if the patient had unprotected sex?
2 pills
Emergency
Barrier for 7d
258
An elderly woman presents with a single episode of brown stained vaginal discharge. What is the most likely diagnosis?
Atrophic Vaginitis
259
A woman at 32 weeks gestation presents with reduced foetal movements, bradycardia and haematuria. She also complains of severe suprapubic pain. She has a history of 2 previous C-Sections. What is the most likely diagnosis?
Uterine Rupture
260
What is the most appropriate set of actions when called to assess an agitated patient in hospital?
Assess the patient in an appropriate environment with another person present. Then telephone a consultant and prescribe a tranquiliser.
261
A child with eczema presents with blistering lesions, malaise and fever. What is the most likely diagnosis?
Dermatitis Herpetiformis
262
A woman presents with a small amount of red blood on wiping after sex. Smear and ultrasound both return normal. What is the next best step in investigation?
Hysteroscopy and Biopsy
263
A patient presents with secondary amenorrhoea. She is found to have a prolactin of 7000 and low LH. What is the most likely diagnosis?
Prolactinoma
264
A 38 year old woman presents with secondary amenorrhoea for 6 months. She is found to have a high FSH and LH. What is the most likely diagnosis?
Premature Ovarian Failure
265
A girl presents with secondary amenorrhoea. She is found to have a lacy black rash in her axilla. What is the likely diagnosis?
PCOS (Acanthosis Nigricans)
266
How would you deliver if one twin is breech and the other cephalic?
C-Section
267
What is the most important factor determining delivery mode in a pregnant woman with HIV?
Viral Load
268
A woman presents 4 days after giving birth with offensive discharge. She had a perineal tear during delivery. What is the most likely diagnosis?
Infected suture repair
269
A woman is found to be HPV+ve and have mild dyskaryosis. She is found to have CIN1 at colposcopy.. No treatment is given. When should the next colposcopy take place?
12 months
270
A woman is HIV positive, but undetectable, and enters labour. Which procedure is contraindicated?
Foetal Blood Sampling
271
Which antibodies are checked to test previous exposure to VZV?
IgG
272
A post-menopausal woman presents with post-menopausal bleeding and superficial dyspareunia. What is the most likely diagnosis?
Atrophic Vaginitis
273
What is the ultrasound criteria for pipelle biopsy of the endometrium pre and post menopause?
>10mm pre
| >4mm post
274
A woman has a preterm prelabour rupture of membranes, and complains of painless bleeding. CTG shows foetal distress. What is the most likely diagnosis?
Vasa praevia
275
What is the most common side effect of the contraceptive implant?
Irregular Bleeding
276
Which cancer are patients on combined HRT most susceptible to?
Breast
277
Which cancer are patients on oestrogen only HRT most susceptible to?
Endometrial
278
A 22yo primigravida is found to have an open cervical os at 9 weeks gestation. What is the diagnosis?
Inevitable Miscarriage
279
How would you manage a woman with PPROM who isn't in labour?
Steroids & Erythromycin
280
What is the first question to ask a woman who might be in menopause?
When was your last period?
281
An 18 year old girl presents to her GP complaining on pain and heavy bleeding in the first 2 days of her period ever since menarche. What is the likely diagnosis?
Primary Dysmenorrhoea
282
When is ergometrine contrainidicated?
Hypertension
283
What is the first line investigation for a suspected breast abscess secondary to acute mastitis?
Aspirate and culture
284
What is the first line management of a woman in labour who is at 4cm dilation after 4 hours of pushing?
Artificial Rupture of Membranes
285
How would you manage a patient with a post-partum haemorrhage who is also hypertensive?
Syntocinon
286
Which vaccine should be offered to a pregnant woman with no history of antenatal care who has just moved to the UK?
Pertussis
287
What is the first line management for heavy periods?
IUS
288
A woman is being investigated for infertility, and is found to have bilateral blocked ducts on hysterosalpingogram. What treatment would aid fertility the most?
IVF
289
A lady with Down's Syndrome gets pregnant. her mother wants a TOP, however the patient wants to keep the baby. how should you proceed?
Assess the patient's mental capacity without the mother present.
290
A teenager who is not currently sexually active presents with heavy periods. What is the first line management?
Tranexamic Acid
291
What is the first line management in a woman with stress incontinence with a BMI<30?
Pelvic Floor Exercises
292
A child is born to a patient with poorly controlled diabetes. The newborn is found to have an abnormal, asymmetric moro reflex. What is the likely diagnosis?
Brachial Plexus Injury
293
What is tested for at booking for Hep B?
Hep B surface antigen
294
What is the most common cause of azoospermia?
Varicocele
295
A patient with endometriosis undergoes laparoscopic adhesiolysis. Soon after, she has high crp, low Hb, constipation and absent bowel sounds. What is the likely diagnosis?
Bowel Perforation
296
What is the most appropriate first line management in a patient with offensive, smelly lochia?
Send culture and start empirical antibiotics.
297
During labour, you notice the baby's head appears, then goes back into the uterus. The chin is not visible. Which complication has likely occurred?
Shoulder Dystocia
298
When will exclusive breastfeeders need contraception?
6 months after birth
299
A woman is being investigated for subfertility. All testing is normal except for a prolactin, which is a tiny bit high. What is the likely cause?
Unknown (30%)
300
How would you manage a patient over 18 found to have FGM?
Check to see if any under 18 girls in the family (Might need police/safeguarding referral)
301
When is deinfibulation indicated in FGM?
Type 3 (Narrowing of the vaginal opening) when it's impeding comfortable sex, urination or examination
302
What are the different types of FGM?
```
1 = Removal of clitoris
2 = Removal of clitoris and labia minora
3 = Narrowing of vaginal canal
4 = All other
```
303
What are the clauses of the Abortion Act?
```
A = Affects the physical/mental health of mother/existing children
B = Termination is necessary to prevent grave, permanent injury to pregnant woman
C= That continuance would risk the life of the pregnant woman
D = Substantial risk of serious physical or mental abnormalities
```
304
How is pregnancy terminated medically?
Mifepristone, followed 24/48 hours later by Misoprostol
305
How long should you stay off work after a hysterectomy?
4 weeks or until fully ready
306
When during pregnancy can an anencephalic foetus be terminated?
Whenever
307
How long is the minimum stay in hospital after a hysterectomy?
24 hours
308
How do you calculate estimated due date?
Add 9 months 7 days to the first day of the last menstrual period
309
When should the next smear be after a Large Loop Excision of the Transformation Zone?
6 months
310
What does a 'lambda sign' on USS indicate?
Dichorionic Diamniotic Twins
311
When should Dichorionic Diamniotic twins be delivered?
37 weeks
312
A woman is in the second stage of labour and has been pushing for 30 minutes. The foetus is pressing against the perineum and the CTG becomes pathological. What is the most appropriate next step?
Forceps Delivery
313
How should you manage a patient with PID?
Send home with antibiotics
314
A woman is going travelling for a few months, and would like a form of contraception that will regulate her periods and make them lighter. What should you prescribe?
COCP
315
What is the most appropriate first step in managing a patient with potential pre-menstrual syndorme?
Ask them to complete a menstrual diary
316
A woman would like to start HRT. Her last period was 5 months ago, and she still has a uterus. What should you offer?
Cyclical combined HRT
317
A woman comes for sterilisation. She had unprotected sex since her last menstrual period. What should be done?
Cancel the surgery
318
Which extra tests do pregnant women who smoke over 10 a day need to attend?
Serial growth scans
319
What is the first line treatment for candidiasis?
Oral Fluconazole -> Intravaginal Clotrimazole if oral contraindicated
320
A woman who had anaesthesia during labour develops a headache 24 hours after delivery. What is the most likely cause?
Post-dural puncture headache
321
What should be done if a neonate develops chickenpox?
IVIg
322
What is the most effective way to predict pre-term labour?
Cervical Length
323
What does Gardasil protect against?
HPV 6, 11, 16, 18
324
What are the second line choices for UTI in pregnancy?
Amoxicillin
| Cefalexin
325
What is the 21 week scan most useful for?
Detecting Congenital Heart Disease
326
How is premature ovarian failure tested for?
High FSH
327
What is the most common side effect of Nexplanon (Implant)?
Irregular Bleeding
328
Which ovarian cyst has a ground glass appearance?
Endometrioma
329
How would you investigate suspected testicular torsion?
Exploratory Laparotomy
330
What are semi-circular bruises on a child's thigh most commonly caused by?
Non-accidental injury
331
A newborn presents with inverted ankles and plantarflexion. What is the name of this sign?
Talipes Equniovarus
332
A newborn has a red maculopapular rash around their eyes at birth, what is the likely diagnosis?
Erythema Toxicum
333
A 6 year old child with Down Syndrome presents with bilous vomiting and a distended abdomen. What is the most likely diagnosis?
Volvulus
334
A 7 year old child presents with a headache and secondary nocturnal enuresis. He's lost 2kg. Urine dipstick is normal. What is the likely diagnosis?
Central Diabetes Insipidus secondary to Tumour
335
A toddler has difficulty balancing, cannot build a tower of blocks and has hyperreflexia. Where is the most likely location of a lesion?
Cerebellum
336
A child presents with a lump behind the ear causing it to stick out. As such, you cannot examine the ear directly. What is the most likely cause?
Mastoiditis
337
A child has a 2cm inframandibular mass on the left side. It is painful and a blood film shows toxic left shift with a reactive neutrophilia. What is the most likely diagnosis?
Lymphadenitis
338
How is molluscum contageosum treated?
Reassurance and supportive care
339
What should you give a child who has been seizing for 5 minutes and is displaying signs of respiratory difficulty?
Buccal Midazolam
340
How should you give a flu vaccine to a child with an egg allergy?
IM in hospital
341
A child takes medication for a UTI, and presents with anaemia and jaundice. What is the likely underlying diagnosis?
G6PD Deficiency
342
What condition is a foetus at risk of the if the mother has T1DM?
Neural Tube defects
343
Which hearing test should be used for toddlers?
Pure tone audiometry
344
Which maintenance fluids should you use for children with T1DM?
Not In DKA? 0.9% NaCl w/ 5% Dextrose
| In DKA? Not the Dextrose
345
A child had chickenpox which had crusted over. She now presents with a fever and cool peripheries. What is the cause?
VZ Viraemia
346
What is the definitive test for precocious puberty?
Gonadotropin stimulation test
347
A child with cerebral palsy has hemiplegic weakness and brisk reflexes. Where is the lesion most likely to be?
Pyramidal Tracts
348
Where are fluids given in a child if IV access is difficult to obtain?
Intraosseous
349
An infant presents with signs of heart failure and a systolic murmur that radiates over the precordium. What is the most likely diagnosis?
Ventricular Septal Defect
350
What is the investigation for Orbital/peri-orbital oedema?
Refer to Opthalmologist
| CT of Nasal Orbits
351
A child complains of smelling weird smells; during these episodes they are hard to communicate with. After, they sleep for an hour. What is the most likely diagnosis?
Focal Seizure
352
What most commonly causes IDA in children?
Fussy eating
353
How are nappy rashes with satellite lesions that don't spare the flexures treated?
Clotrimazole
354
How are nappy rashes that spare the flexures treated?
Zinc and castor oil
355
How is scabies treated?
Permethrin
356
A child has a swollen knee. His brother died of a minor head injury. What is the likely underlying diagnosis?
Haemophilia
357
What most commonly causes posterior rib fractures in children?
Non-accidental injury
358
A patient with anxiety disorder stops taking her regular medication. She presents with coarse tremors, agitation and insomnia. Which drugs has she stopped taking?
Benzodiazepines
359
Name one medication which can cause loss of libido?
Cetirizine
360
Deficiency of which vitamin might cause visual disturbances, ataxia and confusion?
Thiamine
361
Which drugs are used in an agitated patient if verbal de-escalation fails?
IM Lorazepam
362
A man on haloperidol develops acute dystonia. Which drug may be useful?
Procyclidine
363
A woman blushes in public and becomes very nervous around people. What is the likely diagnosis?
Social Phobia
364
How would you manage an elderly lady with a poor sleeping pattern in the first instance?
Advice on sleep hygeine
365
Acute management of anxiety in a patient with asthma?
Benzodiazepines
366
Which section would be used to detain a man in public?
136
367
Which drug reduces cravings in alcoholism?
Acamprosate
368
Which drug might worsen Lewy Body Dementia?
Haloperidol
369
Which drug is used to wean off codeine?
Buprenorphrine
370
A patient has dilated pupils, urinary retention and normal obs. Which medication might they have overdosed on?
TCAs
371
What is it called if a person sees flowers on wallpaper, but perceive them as moving snakes?
Illusion
372
What is it called if a person sees things as being smaller than they really are?
Microsopia
373
What is it called if a person feels insects under the skin?
Formication
374
A woman witnesses a car crash and goes blind 2 hours later. What is the most likely diagnosis?
Dissociation Disorder
375
What is the first line treatment for ADHD?
Parental advice and support sessions
376
Which side effect of citalopram is key to discuss with young people?
Sexual Dysfunction
377
Which area of the brain is likely affected in someone presenting with innapropriate behaviour?
Frontal Lobe
378
Which area of the brain is likely to be affected first in someone presenting with dementia?
Hippocampus
379
What is extracampine?
The sense of feeling a presence/movement in the absence of stimulus (ie. someone being near you)
380
What is flight of ideas a sign of?
Mania, not psychosis
381
What is Fregoli Syndrome?
Two or more people are the same person, changing disguises in order to deceive
382
What is Capgras Syndrome?
Believing someone close to you has been replaced by an imposter
383
What is Ekbom Syndrome?
The delusion that you are infested by insects.
384
What is Factitious Disorder/Munchausen's
Consciously feigning illness in order to 'take the sick role'
385
What is Malingering?
Consciously feigning illness in order to receive treatment or for financial gain
386
What is depersonalisation?
The feeling of being detached from one-self (ie. I feel as if I'm not real)
387
What is Word Salad?
Incoherent speech where real words are used to make nonsensical sentences.
388
What is perseveration?
The repetition of ideas or words despite an attempt to change the topic
389
What is a section 5(2) order used for?
Detaining an inpatient in a hospital for 72 hours for mental health assessment by 2 doctors. During this period, patients still have the right to refuse treatment, but cannot appeal or leave.
390
What is a section 2 order used for?
Detaining a patient for 28 days for mental health assessment, during which the patient cannot refuse treatment, but can appeal.
391
What is a section 3 order used for?
Detaining a patient for 6 months for treatment of a psychiatric disorder. This can be extended once by 6 months, then by 12 month increments thereafter.
392
What is a section 136 order?
Used by police to take someone suspected of having a psychiatric disorder to a safe place when in public.
393
What is a section 135 order?
Used by police to remove a person suspected of being a threat to themselves or others due to psychiatric reasons when in their own home.
394
What is a section 4 order?
Used to detain someone suspected of having a psychiatric disorder for 72 hours for emergency treatment.
395
What is a section 5(4) disorder?
Used by a registered nurse to detain an inpatient for 6 hours for a mental health assessment.
396
Under which section might leave be offered?
17
397
What is the most important side effect of quetiapine?
QT Prolongation
398
How would you manage clozapine-induced hypersalivation?
Hyoscine
399
Which class of medications should be avoided with SSRIs and why?
Triptans, as can increase the risk of serotonin syndrome
400
What should be prescribed if a course of NSAIDs are prescribed to someone on SSRIs?
PPI
401
What are the main side effects of risperidone?
Prolactinaemia
| Dyslipidaemia
402
What important complication of atypical antipsychotics must you be aware of when using them in elderly patients?
Stroke/VTE
403
Which side effects are considered 'extra-pyramidal'?
Dystonia
Akathisia
Parkinsonism
Tardive Dyskinesia
404
Which side-effects are common across atypical antipsychotics?
Sedation, weight gain, hyperglycaemia
405
What happens to cloazpine levels if a smoker decides to quit?
They increase
406
How would you manage a patient who develops dystonia whilst on an atypical antipsychotic?
Anticholinergic
407
Ho would you manage a patient who develops akathisia whilst on an atypical antipsychotic?
Switch drug/lower dose
408
How would you manage a patient who develops tardive dyskinesia whilst on an atypical antipsychotic?
Switch Drug
| Tetrabenazine
409
Which features of depression might worsen for 2 weeks when starting an SSRI?
Suicidal Ideation
| Anxiety
410
How long should an SSRI be continued after becoming effective, if this is a relapse of previous depressive episodes?
2 years
411
Why wouldn't you use a TCA if there is a risk of suicide?
Fatal in overdose
412
What can low dose TCAs be used for?
Aiding sleep
413
What is the most common side effect of TCAs?
Urinary retention, dry mouth, blurry vision (anticholinergic)
414
```
What class of medication are:
Phenelzine
Isocarboxacid
Selegiline
Tranylcypromine
?
```
MAOIs
415
Which benzo has the shortest half-life, hence has the most potent withdrawal effects?
Lorazepam
416
How do you safely withdraw from benzodiazepines?
Reduce the dose by 1/8th every week until it's half the original dose, then repeat.
417
What is Flumanezil?
Benzodiazepine antagonist, used in benzo/z-drug overdose
418
What are Z-Drugs?
Benzos that treat insomnia (eg. zopiclone)
419
Which side effect of Z-drugs is important to consider when prescribing them?
Increased risk of falls
420
What might dexamphetamine be used to treat?
Narcolepsy
| ADHD
421
What are the key side effects of lithium?
Mild tremor
Hypothyroidism
Nephrogenic DI
Eyebrow hair loss
422
What are the symptoms of lithium toxicity?
```
>1.2 mmol/L
Coarse tremor
Hyperreflexia
Nystagmus
Ataxia
```
423
How should you monitor lithium use?
Every 3 months for lithium levels
| Every 6 month for U&Es and TFTs
424
What might cause lithium overdose?
Dehydration
Deliberate
Drugs (NSAIDs, ACEi, Diuretics)
425
What might lithium use in pregnancy cause?
Ebstein's Anomaly
426
What is Ebstein's Anomaly
Tricuspid regurgitation due to a defect in the tricuspid valve
427
What is the most classical side effect of lamotrigine?
Severe Skin rash (Steven-Johnson Syndrome)
428
What is the most common method of suicide?
Hanging
429
How would you manage Neuroleptic Malignant Syndrome?
Dantrolene
| Bromocriptine
430
A patient who recently started on an atypical antipsychotic presents with confusion, muscular rigidity and hyperthermia. What is the most likely diagnosis?
Neuroleptic Malignant Syndrome
431
Which enzyme is most commonly raised in Neuroleptic Malignant Syndrome?
Creatine Kinase
432
A patient on an SSRI presents with a hyperacute onset of Confusion, jerking, hyperthermia and tachycardia. What is the likely diagnosis?
Serotonin Synrome
433
Which antipsychotic most commonly causes Neuroleptic Malignant Syndrome?
Haloperidol
434
What are the indications for ECT?
Euphoric (Mania)
Catatonia
Tearful (Life-threatening depression)
435
Name one absolute contraindication to ECT.
Raised intracranial pressure
436
What are the main side-effects of ECT?
Retrograde Amnesia
Cardiac Arrhythmias
Headache/Nausea
437
How does CBT work?
Identifying and challenging the thought processes that lead to emotions and behaviours allows them to be better coped with.
438
What is Beck's negative cognitive triad?
Negative self-view
Negative future view
Negative world view
CBT based on this model
439
What is Psychodynamic Psychotherapy?
Therapy focusing on the psychological roots of conflicts in order to develop a deep-seated change in personality and emotional development.
440
What are the DSM-V diagnostic criteria for Delirium?
Acute fluctuant cognitive impairment with direct evidence that the disturbance is a direct consequence of another medical condition
441
Which medication used in Alzheimer's is associated with delirium?
Memantine
442
How is delirium diagnosed?
Confusion Assessment Method
Has to have:
Acute, fluctuating inattention
with one of:
Disorganised thinking
altered level of consciousness
443
How is delirium managed?
Treat the cause
Avoid anticholinergics
PO antipsychotics in dementia with infection
444
When is IM lorazepam indicated?
When in need of rapid tranquilisation and oral medications aren't an option
445
What is the first line management of agitated patients?
De-escalation
446
How would you manage a neuroleptic naive, agitated patient who failed to respond to verbal de-escalation and IM lorazepam?
Onlanzapine 1h post-lorazepam dose
447
What are the core features of Depression?
Low Mood
Anhedonia
Anergia
448
What is atypical depression?
Subtype characterised by somatic symptoms, such as weight gain and hypersomnia
449
How is Depression severity scored?
Mild = 5 symptoms, mild functional impairment
Moderate = Mild to severe functional impairment
Severe = Most symptoms, severe functional impairment +- Psychotic features
450
How is depression managed in children?
CBT, family therapy/IPT, lifestyle advice, watchful waiting with regular follow up
Fluoxetine if all measures fail
451
How often should you review a suicidal patient?
Every week
452
When should you trial an SNRI in depression management?
When trials of two separate SSRIs have been ineffective
453
Which SSRI is only likely to be used in major depressive episodes?
Paroxetine
454
What is the risk in using paroxetine in pregnancy?
1st Trimester: Congenital Heart Defects
| 3rd Trimester: Persistent Pulmonary Hypertension
455
Which medication is used to treat rapid cyclic Bipolar Affective Disorder?
Sodium Valproate
456
What is the next step of mania management if lithium is ineffective alone?
Add Valproate
457
What is the next step in management if lithium is poorly tolerated?
Replace with Olanzapine/Valproate
458
What are Schneider's First Rank Symptoms?
Delusions
Passivity
Thought Disorders
Auditory Disorders
459
Which symptoms are included in 'thought disorders'?
Insertion
Withdrawal
Broadcasting
460
Which symptoms are included in 'auditory disorders'?
Echo
3rd Person Voice
Running Commentary
461
What is residual schizophrenia?
When a person with schizophrenia exhibiting both positive and negative symptoms progresses to exclusively displaying negative symptoms
462
What is the monozygotic twin concordance of schizophrenia?
50%
463
What is the dopamine hypothesis of schizophrenia?
+ve symptoms = increased DA in mesolimbic tract
| -ve symtpoms = decreased DA in mesocortical tract
464
What is simple schizophrenia?
Negative symptoms only
465
What is Hebephrenic Schizophrenia?
Disorganised mood and speech
466
What is Zuclopenthixol Decanoate?
Used as once-monthly IM depot in non-compliant psychotic patients
467
How should you monitor patients on anti-psychotics?
Weight and Waist every week for 6 weeks, then at 12 weeks with HR/BP, then annually with HR/BP
468
What is the DSM V criteria for diagnosis of a Schizoaffective Disorder?
2 episodes of psychosis, with one lasting >2 weeks without mood disorder symptoms, and one with obvious overlap between psychotic features and features of affective disorders
469
How would you manage a person with Bipolar type Schizoaffective Disorder?
Fluoxetine (for depressive symptoms) + Olanzapine (for manic/psychotic symptoms)
470
Which psychiatric symptoms may be steroid-induced?
Psychosis
| Depression
471
What is Delusional Disorder?
Persistent (>3 months) delusions without hallucinations
472
Which type of therapy, alongside CBT, is particularly useful in Delusional Disorder?
Psychoeducation
473
Which questionnaire is used to assess anxiety?
GAD-7
5=mild
10=moderate
15=severe
474
Which medication should you never give to people with anxiety?
Benzos
475
What are the stages of medical anxiety management?
1) SSRI
2) Different SSRI
3) Venlafaxine
4) Pregabalin
5) Quetiapine
476
What is the second line management for Panic Disorder?
12 weeks change to TCA
477
Which scale is used to assess OCD?
Yale-Brown Score
478
How long must symptoms last for a reaction to be considered an 'Acute Stress Disorder'?
3d - 1m
479
How is adjustment disorder different to depression?
Adjustment disorder has no biological signs of depression (insomnia, loss of appetite etc)
480
What are the core symptoms of PTSD?
Re-experiencing the event
Avoidance of triggers
Hyperarousal
481
How are rating scales used in assessment of alcohol dependency?
1st Line = AUDIT
If >20
2nd Line = SADQ
482
When should someone with alcohol withdrawal be managed as an inpatient?
High risk of developing seizures, Wernicke's or Delirium Tremens
483
Which medication is used to treat delirium tremens?
Lorazepam
484
When do opiate withdrawal effects start, peak, and end?
6h after injection
36-48h
5-7d
485
What are Cluster A personality disorders?
Weird
| Paranoid, schizoid, schizotypal
486
What are Cluster B personality disorders?
Wild
| Dissocial, Borderline, Histrionic, Narcissistic
487
What are Cluster C personality disorders?
Worried
Anankastic
Anxious-Avoidant
Dependent
488
What is splitting?
Viewing something as all good or all bad
489
What is identification?
Dealing with emotions by modelling behaviour on someone else.
490
When should patients with eating disorders be considered high-risk and warrant immediate admission?
```
<70% expected BMI
Losing 1kg a week
Septic
HR <40bpm
Long QT
Suicide Risk
```
491
Which tests are raised in eating disorders?
```
Cortisol
Cholesterol
Carotene
GH
Salivary Glands
LFTs
```
492
What is the DSM-V diagnostic criteria for Anorexia Nervosa?
Calorie Restriction
Deliberate Weight Loss
Distorted Body Image
493
How does first line management of eating disorders differ between children and adults?
```
Children = Family Therapy
Adults = CBT-ED
```
494
What is Dissociative Fugue?
Loss of memory in response to trauma resulting in travelling beyond normal range
495
How long must symptoms persist for MUS to be considered Somatisation Disorder?
2 years
496
How is Alzheimer's managed?
```
1 = Anticholinesterases (donepezil, rivastigmine, galantamine)
2 = NMDA partial receptor agonist (Memantine)
```
497
What are the levels of learning disability defined by IQ?
```
Mild = 50-70
Moderate = 35-50
Severe = 20-35
Profound = <20
```
498
In which syndrome do children exhibit a characteristic 'high pitched, cat like cry'?
Cri du chat Syndrome
| 5q deletion
499
When must barrier contraception be used for 7 days if a patient is using the patch?
If they go without a patch on for over 48 hours
500
Which disorder presents with slow, twisting movements of the limbs with dystonia due to damage to the basal ganglia and substantia nigra?
Dyskinetic Cerebral Palsy
501
How would you manage umbilical cord prolapse?
Elevate the presenting part, then ask the mother to go on all fours
502
Which cardiac abnormalities are associated with Turner's Syndrome?
Coarctation of the aorta
| Bicuspid Aortic Valve (Ejection Systolic Murmur)
503
How would you manage a diabetic pregnant woman at high risk of premature labour?
Admit for steroids, and monitor BMs with a sliding scale
504
When can a child squat to pick up a ball?
18 months
505
When can a child pull to standing?
8-10 months
506
Which form of contraception can be used alongside cyclical combined HRT?
Progestogen Implant
507
Why can't the injectable contraceptive be used in woman over 50?
Reduces bone mineral density
508
In which foetal position might women experience an earlier urge to push?
OP
509
How might fibroids be temporarily reduced in size prior to surgical removal?
GnRH Agonists (Leuprolide)
510
What are the criteria for immediate referral to hospital in a case of suspected bronchiolitis?
```
Signs of respiratory distress
RR over 70
Sats <92%
Central Cyanosis
Apnoea
```
511
What might maternal anti-epileptic use cause?
Neural Tube Defects
| Cleft Palate
512
For how long should HRT be offered to women with premature ovarian failure?
Until 51yo
513
What should a COCP user do if 2 pills are missed in week 3?
Finish pack, omit pill-free interval
514
Can you breastfeed with anti-epileptics?
Yes
515
What is in the 6 in 1 vaccine?
```
Diptheria
Tetanus
Pertussis
Polio
Haemophilus Influenzae B
Hepatitis B
```
516
Which vaccines are given at birth?
BCG if RFs
517
Which vaccines are given at 2 months?
6in1
Oral Rotavirus
Men B
518
Which vaccines are given at 3 months?
6in1
Oral Rotavirus
PCV
519
Which vaccines are given at 4 months?
6in1
| Men B
520
Which vaccines are given at 12-13 months?
Hib/Men C
MMR
PCV
Men B
521
Which vaccines are given yearly between 2-8 years?
Flu
522
Which vaccines are given at 3-4 years?
Pre-school booster (Diptheria, Tetanus, Pertussis, Polio)
| MMR
523
Which vaccines are given at 12-13 years?
HPV
524
Which vaccines are given between 13-18 years?
3-in-1 Teenage booster (Tetanus, Diptheria, Polio)
| Men ACWY
525
How is eczema managed?
Emollients -> Add Steroid -> Bandages and Ciclosporin
526
When would expectant management of miscarriage not be appropriate?
Risk of haemorrhage (late)
Previous traumatic event
Risks of adverse effects should haemorrhage occur
Evidence of infection
527
In which congenital syndrome might you see supravalvular aortic stenosis?
William's Syndrome
528
In which syndrome might you see a small chin, posterior displacement of the tongue and cleft palate?
Pierre-Robin Syndrome
529
What are the most common complications of measles?
*Otitis Media
Pneumonia
Encephalitis
530
Name a rare, but serious, complication of measles that occurs years after infection.
Subacute Sclerosing Panencephalitis (5-10 years later)
531
What are the features of an atypical UTI?
Poor urine flow
No recovery in 48 hours
Abdominal Mass
Seriously ill
532
At what age would a child start to say 'mama' and 'dada'?
9-10 months
533
Which medication is used to prevent delirium tremens in hepatic failure?
Lorazepam
534
Which cardiac abnormality most commonly occurs in patients with Duchenne's Muscular Dystrophy?
Dilated Cardiomyopathy
535
How is APGAR scored?
2 = >100HR, Strong cry, Pink, Active Movement, Coughs
1 = <100HR, Weak cry, peripheral cyanosis, limb flexion, grimace
0 = No pulse, No resp effort, cyanotic, flaccid, no reflex irritability
536
Which medication might be used to treat spasticity in Cerebral Palsy?
Baclofen (Muscle relaxant)
537
What term describes a white, shiny mass projecting from the wall of a dermoid cyst to the centre?
Rokitansky Protuberance
538
Which treatment for hyperemesis gravidarum comes with a risk of extrapyramidal side effects?
Metoclopramide, hence use should be restricted to less than 5 days
539
At what age can children talk in short sentences of 3-5 words?
2.5-3y
540
At what age do children have a vocabulary of 2-6 words?
12-18 months
541
At what age do children respond to their own name?
9-12m
542
What is the first line management option for Impetigo?
Topical Hydrogen Peroxide, exclude from school until all lesions are crusted and healed
543
Which drug is used to treat PTSD if CBT and EMDR are ineffective?
Venlafaxine
544
When is Ulipristal contraindicated?
Patients on asthma controlled by steroids.
545
For how long is barrier contraception needed if switching from the IUD to COCP in the first 5 days of the cycle?
Not needed
546
Which medication is used to treat Acne and Hirsutism due to PCOS?
Co-cyprindiol
547
When can a child safely be managed at home after a febrile convulsion?
```
Over 18m
Clear, non-serious diagnosis
<5min
Complete recovery within an hour
Not on Abx
```
548
Why does Kallman's cause delayed puberty?
Hypogonadotrophic hypogonadism
549
Which antibiotic is used prophylactically for hysterectomies?
Co-amoxiclav intraoperatively
550
How should delivery be managed in pregnant women who present with Herpes during pregnancy?
From 36 weeks, oral aciclovir until delivery
551
Which hormone is high in PCOS?
LH
552
How are prolapses staged?
```
POPQ
1= 1cm above hymen
2= 1cm above/below hymen
3=Uterus protrudes outside vagina
4=Complete eversion
```
553
What rate of dilatation would be expected in the first stage of labour in a primigravida?
0.5-1cm an hour
554
Where would a complete hydatidiform mole typically metastasise to?
Lungs
555
What would you do if a woman was found to have a bishop's score of less than 6 when attending for induction of labour?
Vaginal PGE2
556
What is the risk of miscarriage in CVS?
0. 7% within 14 days
| 1. 3% within 30 days
557
What is the rate of miscarriage in Amniocentesis?
0.6%
558
How is PID managed?
IM ceftriaxone stat
| Metronidazole/Doxycycline 14 days
559
What is Fitz-Hugh-Curtis Syndrome?
UQP, Peri-Hepatitis due to Chlamydia PID
560
When do symptoms have to present to be considered Adjustment Disorder?
Symptoms must have presented within 3 months of the change, and must have lasted less than 6 months
561
What is the most common cause of DIC in pregnancy?
Placental Abruption
562
How is epilepsy diagnosed?
2 or more unexplained seizures over 24 hours apart. EEG used for classification purposes, not diagnosis.
563
When should B-HCG levels return to normal after GTD evacuation?
6 months
564
Which chemo is choriocarcinoma sensitive to?
Methotrexate-based
565
How should a child with an atypical (non-e coli, non-responsive to treatment in 72h) UTI be investigated?
Urgent USS
| Routine DMSA & MCUG
566
When might interpersonal therapy be more use than CBT?
Depression related to loss of a loved one
567
What is the most common site of referred ovarian pain?
Periumbilical region (T10)
568
How many words should children be able to use at 2 years old?
50
569
What is Eisenmenger Syndrome?
Long standing LtR shunt due to congenital heart defect causes pulmonary hypertension, and reversal into a cyanotic RtL shunt.
570
What is vulvodynia?
Pain in the vulvovaginal region lasting for >3m with no identifiable cause
571
How should dysmenorrhoea be managed in a patient with asthma?
Paracetamol -> hormonal contraceptive
572
How are moderate to severe PMS' managed?
COCP
| SSRI
573
What is neurosis?
An inappropriate emotional or behavioural response to a perceived stressor
574
What is Ectopia Vesicae (Bladder exstrophy)?
Herniation of the bladder through an anterior abdominal wall defect. Surgically managed
575
How is DDH managed before the child starts walking?
Brace -> Pavlek Harness
| Hip reduction/osteotomy if diagnosed when walking
576
What is Gaucher's Disease?
Lipid storage disorder presenting with hepatosplenomegaly
577
What should be given to women with anti-phospholipid syndrome and history of miscarriage during their next pregnancy?
Low dose aspirin and LMWH from positive pregnancy test to delivery
578
What is paraphimosis?
Foreskin becomes stuck behind the glans, can strangulate the glans.
579
How are Wilm's Tumours treated?
Radical nephrectomy and Chemo. Radio if more advanced. 90% Survival
580
What is the first line investigation for Hirchsprung's?
Barium Enema (shows funneling)
581
Which CCD has an ejection systolic murmur at the upper left sternal edge and fixed wide splitting of S2?
ASD
582
Which CCD has a loud pansystolic murmur at the left lower sternal edge?
VSD
583
How does Noonan's present?
Webbed Neck
Trident Hairline
Pectus Excavatum
Pulmonary Stenosis
584
How does Patau's present?
Microcephaly
Cleft Palate
Polydactyly
VSD
585
How does Turner's present in a neonate?
Lymphoedema of hands/feet
586
Which cardiac abnormality is a complication in Fragile X?
Mitral Valve Prolapse
587
How does congenital syphylis present?
Rhinitis
Saddle-nose
Deafness
Heaptosplenomegaly
588
How do Prader-Willi and Angelman's differ?
```
PW = Loss of paternal
Angelman's = Loss of maternal
```
589
What is the most common cause of Down's Syndrome?
Meiotic non-dysjunction
590
How might you investigate tense fontanelle in a neonate?
Cranial USS
591
What are the complications of cigarette smoking in pregnancy?
IUGR
Miscarriage
Stillbirth
592
How is Talipes Equinovarus managed?
Ponsetti Method (Plaster Casting and Bracing)
593
What is the difference between a posterior and an anterior tongue tie?
Frenulum is visible in anterior tongue ties
594
BV vs Trichomonas?
```
BV = Fishy, grey-white discharge
T = Yellow-green discharge, strawberry cervix
```
595
What is the likely cause of haemorrhage in a neonate whose mother received no perinatal care?
Vitamin K Deficiency
596
How long can you observe before starting Syntocinon in a non-bleeding patient who hasn't delivered the placenta?
An hour (Start breastfeeding during this period)
597
What is the first line treatment for Primary amenorrhoea secondary to a prolactinoma?
Dopamine Receptor Agonist (Bromocriptine/Cabergoline)
598
How would you distinguish Parvovirus and Roseola Infantum?
Rash starts on the trunk in roseola, on the face in parvovirus
599
What is the best treatment of social phobias
CBT
600
What is foetal hydantoin syndrome?
Symptoms caused by maternal phenytoin/carbamazepine use. Causes IUGR, Microcephaly, Cleft Lip, Hypoplastic fingernails
601
What is the likely diagnosis if a child presents with systemic illness and an unhealed burn?
Toxic Shock Syndrome
602
Which patients should be screened for thyroid disorders in pregnancy?
Current/Past thyroid disease
Thyroid disease in a first degree relative
Autoimmune Conditions
Diabetes
603
When is barrier contraception not required after inserting an IUS?
Day 1-5 of the menstrual cycle
604
What are the main complications of tubal ligation sterilisation?
Ectopics
| Wanting reversal in the future
605
Which HPV strains cause genital warts?
6/11
606
When does the uterus reach the umbilicus?
20 weeks
607
How many cysts must be present to meet the 'cyst' criteria for PCOS?
at least 12 in one, ranging from 2-9mm
608
Is mefenamic acid used in fibroids?
no
609
When should refer cases of Otitis Media with effusion to ENT?
Down's
| Cleft Palate
610
What is used first line for anaesthesia in mild to moderate pain in children?
Oral/Intranasal Midazolam
611
Which antibiotic is used in Mycoplasma Pneumonia in children?
Erythromycin
612
What are the categories of c section?
```
1 = life threatening, within 30m
2 = maternal/foetal compromise but not life threatening within 75m
3= delay in labour induction
4 = elective
```
613
Which fractures are associated with child abuse?
Humeral
Radial
Femoral
614
What are the forms of spastic CP?
Unilateral
Bilateral
Diplegia (legs)
615
Which form of Cerebral Palsy occurs due to basal ganglia damage and presents as chorea, dystonia and athetosis?
Dyskinetic
616
Which bacteria most commonly causes late onset neonatal sepsis?
Coagulase negative strep
617
What is Purpura fulminans?
Haemorrhagic skin necrosis from DIC
618
How would you assess a toddler's hearing 6m-3y?
Visual Reinforcement Audiometry
619
What is Positional Talipes?
Foot remains in foetal position due to intrauterine compression
Foot can be fully dorsiflexed
620
How is CP function classified?
Gross Motor Function Classification System
621
Where are the lesions in spastic CP?
UMN
| Pyramidal/Corticospinal Tracts
622
How is NEC managed?
Bowel rest (parenteral feeding)
Broad Spectrum Abx
Laparotomy if perforation
623
What is kernicterus?
Bilirubin encepalopathy
624
Which maternal blood group most puts neonates at risk of ABO incompatibility haemolysis?
O
| Usually Anti-A Abs
625
How does persistent pulmonary hypertension present?
Cyanosis at birth
No signs of cardiac defects
Hx of meconium, difficult birth, sepsis
626
What can cause Chronic Lung Disease of prematurity?
Infection, Ventilation, O2 Toxicity
627
Which maternal condition commonly predisposes to respiratory distress syndrome?
Diabetes
628
Neonate with ground-glass x ray?
Respiratory Distress Syndrome (surfactant deficiency)
629
How is meconium ileus managed?
Gastrograffin Enema
| Surgery
630
When would you add ABx to management of Meconium Aspiration?
Signs of infection
631
What might maternal benzo use cause?
Cleft Lip
632
What is the first line immediate management for CDH?
NG Tube and suction
633
What is the gold standard investigation for tracheo-oesophageal fistula?
Gastrograffin Swallow
634
How is tracheo-oesophageal fistula managed?
1) Replogle tube for drainage
| 2) Surgery few days after birth
635
What sign is seen on USS of biliary atresia?
Triangular cord sign
636
What are the gold standard and confirmation tests for Biliary Atresia?
```
GS = TIBIDA isotope scan
Confirmation = ERCP
```
637
What is horseshoe kidney?
Renal Agenesis
638
When are DMSA scans performed?
2 months after UTI
| All with recurrent/atypical
639
What is a medullary spongy kidney?
Multicystic kidney
640
What does the Potter Sequence cause?
Bilateral Renal Agenesis
| AR Polycystic Kidney Disease
641
When are MCUG scans performed?
VUR suspected on USS
642
When should congenital anal abnormalities be surgically repaired?
9m
643
How should bilateral cryptochordism at birth be managed?
Referral to surgeons
644
How is unilateral cryptochordism managed?
Review at 6-8weeks
Review at 3m
Refer at 3m
645
What might a sacral dimple above the nasal cleft indicate in a constipated child?
Spina Bifida Occulta
646
How is paediatric constipation managed?
Osmotic (Movicol)
Stimulant (Senna)
Maintenance with movicol
647
What is used in GORD if omeprazole is ineffective?
Ranitidine
648
Which syndrome is Pyloric Stenosis most associated with?
Turner's
649
What is the most common form of intussusception?
Ileum through to caecum through ileocaecal valve
650
How is Meckel's Diverticulum investigated?
Technetium Scan = greater uptake by gastric mucosa
651
When is Meckel's surgically treated?
Obstruction
Perforation
Bleeding
652
How is GE investigated in a very young patient?
Stool electron microscopy (viral)
653
How is paediatric IBD managed?
Aminosalicylates -> Steroids -> Biologics
654
How is Hirchsprung's managed?
Bowel irrigation -> Endorectal pull-through
655
What is the most common cause of encopresis?
Constipation with overflow
656
A child presents with eczema, cold abscesses and coarse facial features. What is the likely diagnosis?
Hyper IgE
657
What might cause telangiectasia in the eyes and cerebellar ataxia in a child?
Ataxia Telangiectasia
658
What is Duncan Disease?
Failure to mount an immune response to EBV. Death from initial infection or secondary B-Cell lymphoma
659
How is severity of croup assessed?
Westley Score
660
How is sinusitis that's lasted more than 10 days managed?
Corticosteroid
661
How do you distinguish between pneumonia and bronchiolitis?
Coarse crackles = pneumonia
| Fine crackles = bronchiolitis
662
What is the most common childhood arrhythmia?
SVT
663
What is the most common cause of acute renal failure in children in the uk?
Haemolytic Uraemic Syndrome
664
A child has a metabolic acidosis, hyperammonaemia and a cheesy/sweaty smell. What is the likely diagnosis?
Isovalaeric Acidaemia
665
How does galactossaemia present?
Hepatomegaly, hypoglycaemia
666
Which form of CAH shows feminisation in an xy genotype?
17-a-hydroxylase deficiency
