2022 Paper

Question 1

Widespread clustered blisters, sparing face
Lesions begin on abdomen
Presents in late 2nd or 3rd trimester
Diagnosis?

Answer 1

Pemphigoid gestationis
Rare pruritic AI bullous disorder

Needs use potent topical steroids or oral prednisolone

Question 2

Presents in 3rd trimester or immediately post-partum

Begin on lower abdomen, involving pregnancy striae. Extends to thigh, buttocks, legs, arms, sparing umbilicus

Rarely involves face, hands, feet

Diagnosis?

Answer 2

Polymorphic eruption of pregnancy

Which is the same as pruritic urticarial papules and plaques of pregnancy

Question 3

Rash present as excoriated papules on extensor limbs, abdo, shoulder

Diagnosis?

Answer 3

Prurigo of pregnancy –> common pruritic disorder

Affects 20% of normal pregnancies, do LFTs to exclude obstetric cholestasis

Question 4

Pruritic follicular eruption with papules and pustules affecting trunk, can involve limbs

o 2nd or 3rd trimester, resolve a week after delivery

o SS: acne (considered a type of hormone-induced acne)

Answer 4

Pruritis folliculitis
Manage with topical steroids

Question 5

Commonest pregnancy rash

Answer 5

Atopic eczema

–> emollients and bath additives

Question 6

T1DM DKA first-line management?

Answer 6

Fluid Bolus

Question 7

Child presenting with bump behind ear

Answer 7

Mastoiditis

Question 8

Kid with 2cm mass (inframandibular) on left side, painful – blood film shows: toxic left shift with reactive neutrophilia.

Answer 8

Lymphadenitis

Question 9

Child presenting with symptoms of muscular dystrophy, what should be measured?

Answer 9

Creatine Kinase
–>Duchenne Muscular Distrophy

Question 10

Calf hypertrophy

Answer 10

Duchenne Muscular Distrophy

Question 11

Worst prognostic factor of schizophrenia?

Answer 11

Gradual Onset
–> this is the worst one but other include:
strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant

Question 12

23 yo with depression, isn’t sleeping very well. What tx?

Answer 12

Mirtazapine

Question 13

What effect does continued maternal use of sodium valporate have on the fetus?

Answer 13

Spina bifida, neural tube defect

Question 14

What effect does continued maternal use of lithium have on the fetus?

Answer 14

Ebstein’s anomaly

Question 15

Woman has an intrauterine device/system put in. How often does she have to check for the strings?

Answer 15

Every month

Question 16

63 yo lady just had a vaginal hysterectomy, she works as a carer in a care home. How long does she have to take off work assuming she has no complications?

Answer 16

6 weeks
–> she does heavy lifting

Question 17

Percentage increase chance of developing T2DM after having GDM

Answer 17

50%

Question 18

Woman with controlled hypothyroidism presents to GP as just fell pregnant, what should be done about her levothyroxine during pregnancy?

Answer 18

Increase dose

Question 19

Women recently underwent LLETZ for CIN(1 or 2?), when should next smear be?

Answer 19

6 months

Question 20

Woman with bleeding, pain, and woody uterus. CTG showed fetal tachycardia. Dx?

Answer 20

Placental abruption

Question 21

Best test for predicting preterm labour?

Answer 21

Cervical length

Question 22

LH:FSH ratio 3:1

Answer 22

PCOS

Question 23

Neonate, no femoral pulses, hepatomegaly, blue. Dx?

Answer 23

Coarctation of the aorta

Question 24

Small child with UTI, name test where dye is injected into urinary tracts to visualise them

Answer 24

Micturating cystourethrogram

Question 25

Girl with barking cough and stridor. What is the scoring system for this condition?

Answer 25

Westley croup score

Question 26

Perianal itching especially at night. What’s the best treatment option?

Answer 26

Mebendazole --> This is an imperial favourite if it doesn't come up I will be mad

Question 27

Head lice what do you suggest?

Answer 27

Head combing and Malathion

Question 28

urinary incontinence dementia and bradyphrenia gait abnormality

Answer 28

Normal pressure hydrocephalus

Question 29

Best opiate replacement (OST) for 6 week pregnant lady on a menagerie of other drugs?

Answer 29

Methadone or Buprenorphine

Question 30

Lady w schizophrenia and actively psychotic declines some physical health intervention, which is the best framework (“act”) to provide treatment under?

Answer 30

Mental Capacity Act --> you cannot treat physical health under the section

Question 31

Pregnant woman had fall, fell on abdomen, Well in herself, no bruising or haemorrhage. Third pregnancy, is Rhesus negative. What should be done before 12 weeks? What should be done between 12-20 weeks? What should be done after 20 weeks?

Answer 31

In pregnancies <12 weeks gestation, anti-D Ig prophylaxis is only indicated following ectopic pregnancy, molar pregnancy, therapeutic termination of pregnancy and in cases of uterine bleeding where this is repeated, heavy or associated with abdominal pain. The minimum dose should be 250 IU. A test for fetomaternal haemorrhage (FMH) is not required. For potentially sensitising events between 12 and 20 weeks gestation, a minimum dose of 250 IU should be administered within 72 h of the event. A test for FMH is not required. For potentially sensitising events after 20 weeks gestation, a minimum anti-D Ig dose of 500 IU should be administered within 72 h of the event. A test for FMH is required.

Question 32

Guy on drugs, depressed mood, paranoid, slow, etc. what drug?

Answer 32

Cannabis

Question 33

Women presenting with hyperreflexia, tremor etc, what drugs did she likely overdose on?

Answer 33

Lithium

Question 34

X-ray image shown of pneumonia. 5 y/o Child, had a fever and BP okay. What drug and what route?

Answer 34

Oral amocixillin

Question 35

white itchy plaque rash pain during intercourse or urination

Answer 35

Lichen Sclerosus

Question 36

itchy, papular rash on genitalia white-lace pattern on the buccal mucosa

Answer 36

lichen planus

Question 37

Diagnostic test for Down's at 15th week?

Answer 37

Amniocentesis

Question 38

Diagnostic test for Down's at <14th week?

Answer 38

Chorionic villus sampling

Question 39

Mum comes in with a child, she saw him swallow a 20p coin in the garden 30 mins ago, but no choking, coughing, etc. What's the best investigation?

Answer 39

X-rays of neck, chest, abdomen

Question 40

A 40 year old woman with uterine fibroids require the active management of the third stage of labour. At which point in labour should IM syntocinon (oxytocin) be administered?

Answer 40

NICE says when the anterior shoulder is out or immediately after birth. However reg said because she had fibroids she would be inclined to give as soon as the shoulder is out

Question 41

A 24-year-old woman with a BMI of 22 kg/m2, has an elective, uncomplicated laparoscopic procedure for removal of a 6 cm simple ovarian cyst. Assuming good postoperative recovery, after how long would she be appropriate to be discharged?

Answer 41

Reg said probably 6 hours after recovery from anaesthetic Rcog says for procedural laparoscopy "If you have had a simple procedure as part of an operative laparoscopy, you may be able to go home on the same day, though you may be asked to stay in hospital overnight." Rcog says if diagnostic laparoscopy you should be able to go home between three and four hours.