2019 Paper

Question 1

45F. Wertheim’s hysterectomy. Last cervical smear 2 years ago. When next smear?

Answer 1

Never
If you have normal histology before hysterectomy and you have a total/radical hysterectomy then you don’t need smears anymore.

Where a hysterectomy is carried out for pre-malignant disease of the cervix (CIN)
or CIN is found, a vault smear (from the top of the vagina) is taken at six months
and 18 months after the operation.

Question 2

Lambda sign on USS. What pregnancy is it and when do you deliver?

Answer 2

You deliver at 37 weeks

Dichorionic pregnancies (triangular placental tissue projection (λ sign) into base of the membrane)

MCDA: from 36 weeks
DCDA: from 37 weeks
MCMA: C-section at 32-34 weeks

Question 3

T sign on USS. What pregnancy is it and when do you deliver?

Answer 3

T sign = monochorionic pregnancies (no placental tissue projection (T-sign) into the base of the membrane) – deliver from 36 weeks

MCDA: from 36 weeks
DCDA: from 37 weeks
MCMA: C-section at 32-34 weeks

Question 4

When do you deliver a MCMA pregnancy?

Answer 4

MCDA: from 36 weeks
DCDA: from 37 weeks
MCMA: C-section at 32-34 weeks

Question 5

Woman has menopausal symptoms and wants to start HRT, last period 6m ago.
What do you give?

Answer 5

Cyclical HRT

Question 6

Woman with dribbling all the time and had to wear a pad.
Dx?

Answer 6

vesicovaginal fistula

Question 7

Woman with stress incontinence, with prolapse + leakage on coughing and standing, 1st line treatment

Answer 7

Pelvic floor exercises

Question 8

Man on ward behaving aggressively, what do you do?

Answer 8

Verbal de-escalation is first then trial of oral lorazepam and then IM lorazepam

Question 9

Vascular risk factors for vascular dementia - how do you treat?

Answer 9

Aspirin

Question 10

There was a chef who kept washing his hand, had loads of obsessions but he was hearing a voice. What did he have?

Answer 10

OCD
OCD can get pseudo-hallucinations – knows it’s not real

Question 11

Paramedic sees a patient die 1 month ago. He is sad and can’t sleep. What Dx?

Answer 11

Acute Stress Reaction
(why do they like this question so much lol)

Question 12

Girl witnesses car crash and goes few hours later blind. Dx?

Answer 12

Conversion Disorder
not 100% sure but don’t know what else it could be

Question 13

Mum with 20 units a day alcohol habit hides in room with 2 day newborn baby and think house is infested . What Dx?

Answer 13

Alcohol withdrawal
could be post partum psychosis as well tbf

Question 14

7 year old with ADHD, 1st line treatment

Answer 14

Parental education

Question 15

Guy scared of public speaking. Doesnt want to leave house.

Answer 15

Social phobia

Question 16

Patient with a bunch of symptoms:
hates queueing in shop, starts blushing, can’t get on public transport.
Which most suggest social phobia?

Answer 16

Blushing

Question 17

Cannot examine ear directly, lump behind ear

Answer 17

mastoiditis (repeat)

Question 18

Infrahyoid lump on neck

Answer 18

lymphadenitis (repeat)

Question 19

Threadworms, what treatment

Answer 19

Mebendazole

Question 20

Kid with constipation, and one episode of blood streaked stool. What Ix.

Answer 20

None necessary

Question 21

Girl with abdo only when going to school, not weekends. What is it and what you tell her?

Answer 21

Functional, come back when you have the tummy pain in the meantime go to school.

Question 22

Kid with pellets, and loose stool sometimes.
Dx?

Answer 22

Overflow diarrhea

Question 23

Kid has a hearing test at age 3 - which one?

Answer 23

Pure tone audiometry

Question 24

Man who thinks body is rotting. What type of delusion is this?

Answer 24

Nihilistic Delusion

Question 25

Guy presents with itching but no cause. In the past has presented with tingling and other symptoms

Answer 25

Somatisation

Question 26

Treatment for candidiasis?

Answer 26

oral fluconazole (or topical clotrimazole if pregnant)

Question 27

Young girl, no sexual hx, white discharge, vulval itching

Answer 27

Vulvovaginitis. Candidiasis in young child suggests immunosuppression

Question 28

Smoker, which extra tests does she require in pregnancy

Answer 28

Serial growth scan

Question 29

Pregnant Lady 28 weeks GA. Protein 1+ in urine, BP normal, what does she have?

Answer 29

Normal pregnancy

Question 30

Woman is pregnant. The fetus is diagnosed with anencephaly. She wants to terminate her 18-week pregnancy because she already has 3 children - which clause of the abortion act does this fall under

Answer 30

E
There is substantial risk that if the child were born it would suffer from physical or mental abnormalities

Question 31

Twins, presenting twin is breech, other cephalic. How to deliver?

Answer 31

C-section because presenting twin is breech