2021 paper

Question 1

A 9-year-old girl is in Paediatric Outpatients following parental concerns about her weight. During the consultation, the girl reveals she is being bullied at school. Her weight is 49kg, and her height is 1.37m (given growth chart with this plotted). Her thyroid function test results are as follows. TSH 3.5mU/L (0.7-4.1), free T4 16 pmol/L (12-22). Which is the most appropriate next step in her weight management?

Answer 1

Refer to a paediatric dietician
–> Some debate about this one but CAMHS won’t help with the weight management in my opinion.

Question 2

A 3-week-old girl has had loose stools since day 2 of life and there are now streaks of blood in the stool. The baby examines well with normal observations and normal findings on abdominal examination, but there is dry skin on the scalp and face. Which is the most likely diagnosis?

Answer 2

2. Cow’s milk protein allergy

Question 3

A 7 year old boy has a history of recurrent chest infections, persistent sinusitis and has been prescribed multiple courses of antibiotics. He has bibasal crepitations and a right-sided apex beat. Which is the most likely underlying diagnosis?

Answer 3

4. Primary ciliary dyskinesia
   –> Kartagener’s syndrome

Question 4

A 3 day old baby girl is not feeding well. Her temperature is 36.7C, heart rate 180 bpm, respiratory rate 66 breaths per minute. There is a systolic murmur and femoral pulses are not palpable. Which is the most likely diagnosis?

Answer 4

Coarctation of the aorta

Question 5

A 7 year old girl has breast buds but no pubic hair. Her height is on the 98th centile and her weight is on the 75th centile. She is otherwise fit and well. There is no significant family history. Investigations show: bone age of 10 years, FSH 3.2 IU/L (<1), LH 3.4 IU/L (<1). Which is the most likely diagnosis?

Answer 5

Central precocious puberty

Question 6

Medications that cause gynecomastia

Answer 6

Drug causes of gynaecomastia:
spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids

Very rare drug causes of gynaecomastia:
tricyclics
isoniazid
calcium channel blockers
heroin
busulfan
methyldopa

Basically I have seen a couple of SBAs where they ask you to pick what is the cause of the gynaecomastia so just be able to recognise the drugs

Question 7

A 5 year old girl in the paediatric Emergency department recently had a sore throat and now has a rash across her lower legs. She is afebrile but has abdominal pain and joint pains in both legs. Her full blood count result is as follows: Hb 110 g/L (115 - 140), WCC 10.3 x 10^9/L (3.8 - 10), platelets 6 x 10^9/L (150 - 400). Which is the most likely diagnosis?

Answer 7

Low platelets therefore ITP
HSP is a small vessel vasculitis ( IgA) and would not cause thrombocytopaenia

Question 8

An 8 year old boy in the Emergency Department has been unable to open his left eye for 1 day. Prior to this he had a cold one week ago. When examining the left eye, it is difficult to open, and he reports pain on all eye movements. The conjunctiva is injected. Which is the most appropriate next step in management?

Answer 8

Refer to specialist

Question 9

A term infant born to a diabetic mother is 4 hours old on the postnatal ward and is noted to be jittery. The capillary blood gas result is as follows: pH 7.37 (7.35 - 7.45), PCO2 5.5 kPa (4.6 - 6.4), PO2 4.9 kPa (8 - 12), glucose 2.4 mmol/L (3 - 6), lactate 2.0 mmol/L (1 - 2). Which is the most appropriate treatment for the baby in this scenario?

Answer 9

IV dextrose

Question 10

A 5-year-old boy in General Practice has bright red blood when opening his bowels for 1 week. He opens his bowels every 3 days. He has no past medical history and is thriving. He has a well-balanced diet and has good fluid intake. There are no safeguarding concerns. Abdominal examination is unremarkable. Rectal inspection reveals a fissure. Which is the most appropriate management?

Answer 10

Osmotic laxative

Question 11

A 6-week-old baby is seen for his routine baby check-in in General Practice with his mother. She has no concerns. A soft systolic murmur is heard on examination. It varies with posture and does not radiate. The child appears well. Which is the most likely diagnosis?

Answer 11

Innocent murmur

Question 12

A 2-year-old in General Practice has a cough. He has reached all of his developmental milestones at the right time so far. Which motor skill would this child have most recently acquired?

Answer 12

Turning one page in a book

Question 13

Mean age Crawling

Answer 13

9 months

Question 14

Mean age : Draw a circle

Answer 14

3 years

Question 15

Mean age: Draw a square

Answer 15

5 years

Question 16

Mean age: Transfers objects from one hand to the other

Answer 16

6 months

Question 17

Mean age: draw a line

Answer 17

2 year

Question 18

Mean age: good pincer grip

Answer 18

1 year

Question 19

An 18-year-old woman has not eaten any solid food over the past week and has been limiting her liquid intake to 500 mL per day. She is preoccupied with being significantly overweight. Which blood test parameter is most likely to be raised in this scenario?
1. Cholesterol
2. Haemoglobin
3. Phosphate
4. Potassium
5. Triiodothyronine (T3)

Answer 19

Cholesterol

Question 20

Switching from fluoxetine to another SSRI

Answer 20

Withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low-dose of the alternative SSRI

Question 21

The Quadruple Test timeframe

Answer 21

14 and 20 weeks of pregnancy

Question 22

Combined Test timeframe

Answer 22

A screening test for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome is available between weeks 10 and 14 of pregnancy.

Question 23

A 27-year-old woman with diabetes reports not sleeping for 1 week. She has recently ended her relationship with her partner of 5 years because she believes that he is a member of the CIA and has been uncharacteristically promiscuous. She states that she hears his voice even when she is not with him in the room. Which medication combination is most appropriate in this scenario?
1. Aripiprazole and sodium valproate
2. Clozapine and lithium
3. Olanzapine and carbamazepine
4. Quetiapine and lithium
5. Risperidone and lamotrigine

Answer 23

Quetiapine and lithium
–> not 100% sure different people had different opinions but in the end we decided this one was probably the right answer

Question 24

A 19-year-old woman writes to her new GP to profess her love for him. In the letter, she describes her belief that they are destined to marry, which she knew to be true after seeing his picture on the surgery’s website. Police have been contacted by her GP after she was seen to be following him home late at night. Which is the most likely diagnosis?

Answer 24

De Clerambault syndrome (erotomanic delusions)
They really like this one as well

Question 25

A 28-year-old man is prescribed regular medication for bipolar disorder. He has also been taking naproxen for a sports injury. He presents to the Emergency Department with ataxia, confusion and tremor. Which medication is most likely to have resulted in his symptoms?

Answer 25

Lithium

Question 26

A 30-year-old woman is assessed at the addictions treatment clinic for her heroin addiction, having never had treatment previously. Which is the most appropriate pharmacological treatment to initiate?

Answer 26

Methadone

Question 27

A 44-year-old man has a 10-year history of using crack cocaine and heroin. He uses both substances once or twice per week and often feels depressed following episodes of excessive use. He developed hepatitis C after sharing needles. He does not describe a strong desire to use these substances, but nonetheless continues to do so. Which diagnosis best describes his presentation?

Answer 27

Harmful use

Question 28

A 33 year old woman takes omeprazole, paroxetine, aripiprazole, and zopiclone for gastro-oesophageal reflux and bipolar affective disorder. She also takes the combined oral contraceptive pill. Her annual blood test show: sodium 135 mmol/L (135 - 145), potassium 4.2 mmol/L (3.5 - 5.3), urea 5.1 mmol/L (2.5 - 7.8), creatinine 63 umol/L (60 - 120), eGFR 90 (>60) and prolactin 622 UI/L (100 - 500). Which medication is most likely responsible?

Answer 28

Aripiprazole

Question 29

A 24-year-old woman in her first pregnancy, is in spontaneous labour on the labour ward. She is using Entonox for analgesia and has now been in the second stage for 3 hours. She has been in good descent from pushing for 2 hours. The baby is in the cephalic presentation in an occipito-anterior position, vertex below the ischial spines. The foetal heart rate has been suspicious for 30 minutes. Which is the most appropriate management in this scenario?

Answer 29

Obs and Gynae reg said Ventouse delivery

Question 30

Organism which causes bronchiolitis?

Answer 30

respiratory syncytial virus

Question 31

Kid is seizing for 5 mins and also difficulty breathing, what should you give?

Answer 31

Oxygen and then Buccal Midazolam ( A-E approach)

Question 32

Girl presenting to GP with hepatomegaly and clotting, and petechiae across chest and arms, seems well. What do you do?

Answer 32

Send them to A&E

Question 33

Woman who is going away for 4 months or 3 weeks with heavy, irregular periods, wants something that will regulate her periods + make them lighter

Answer 33

COCP