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P1EXAM > Clinical > Flashcards

Clinical Flashcards

1
Q

60 years old,female, smoker patient in the ward for preoperative preparation for abdominal hysterectomy due to endometrial carcinoma. Which investigation of the following you don’t require?

-Chest X ray
-Complete blood film
-Coagulation profile
-Cross match and saving
-ECG

A

Coagulation profile

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2
Q

What recreational drug may cause an MI?

A

Cocaine

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3
Q

Management of Hb 6.2

A

O neg blood immediately
/ vs crossmatch 2 units

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4
Q

Patient with an old MI Infarct - ECG finding

A

Pathological Q wave

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5
Q

4 year history of infertility, severe dysmenorrhea and increasing pain with sexual intercourse. O/E: adnexal mass is felt and nodules are palpated along the uterosacral ligaments. Diagnosis?

A

Endometriosis

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6
Q

Superficial burn; severely painful and blistered. Which layer is involved?

A

Superficial layer of the dermis

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7
Q

Uterus is empty on scan and the level of beta hcg decreases

A

Complete miscarriage

Complete - all products expelled
Inevitable - cramping + open cx
Missed - non viable foetus, products inside still

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8
Q

How can you monitor opioid toxicity?

A

Respiratory rate

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9
Q

Pregnant patient (with sickle cell) presents with generalised pruritus, LFTs normal, Serum bile acids elevated. Dx?

A

Obstetric cholestasis

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10
Q

Megaloblastic anaemia is caused by which vitamin deficiency?

A

Folic Acid and B12

BIG B12 and Folate (macrocytic)

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11
Q

A patient with primary infertility, presents with 3 months amenorrhea, elevated FSH and prolactin, Bhcg positive

A

Pregnant

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12
Q

In a pregnant woman suspected to have pulmonary embolism. Investigation of choice?

A

VQ scan
(CT not on the list)

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13
Q

Best screening method for hemolytic anaemia

A

FBC

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14
Q

What is the clinical finding in an incomplete miscarriage

A

Cervix with open os

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15
Q

in a 25 years old lady with 4 previous miscarriages , the most useful investigation would be:

A

Thrombophilia screen

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16
Q

a pregnant women in first trimester has nausea and vomiting with 4+ ketone in urine, the correct management

A

IV fluids and antiemetic as inpatient

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17
Q

FBS
Normal
Borderline
Abnormal

In exam example e.g. FBS is 7.23

A

Normal >7.25
Repeat FBS in 1h if CTG still abnormal

*Borderline [in between]
Repeat FBS in 30 mins

Abnormal <7.2
Consider delivery

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18
Q

Recommended method for delivery of placenta

A

Controlled cord contraction

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19
Q

Patient post date admitted for induction of labour with PG, ARM + oxytocin
Oxytocin given for 6 hrs
Then she developed hyponatraemia what is cause?

A

Excess oxytocin
Stimulates ADH receptor on kidney
Water retention and hyponatraemia
(iatrogenic)

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20
Q

Obstetric cholestasis - what vitamin treatment?

A

Vitamin K
~Prevents bleeding

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21
Q

On USS:
Hypoechoic area in the uterus
Bilateral adnexa clear
What is this caused by?

A

Fibroid?

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22
Q

Patient with fever on 2nd post operative day with increased pulmonary vascular markings and pleural effusions. Dx?

A

Pulmonary oedema

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23
Q

Cause of acute haemolytic reaction in blood transfusion

A

ABO incompatability

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24
Q

36/40 describes gush of fluid, not in labour. What should NOT be part of the examination

A

PV exam
(risk infection)

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25
Q

Perimenopausal, 44y/o with no periods. Wants to stop taking contraception (POP). FSH is 20. When should the FSH be repeated?

A

Internet says about 6 weeks

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26
Q

First investigation in pleuritic chest pain, SOB

A

CXR

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27
Q

Which is not a recognised sign of imminent eclampsia:
a. Headache
b. Epigastric pain
c. Blurred vision
d. Decreased fetal movement
e. Hypertension

A

HTN (?)

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28
Q

Complete mole on USS initial management

A

Suction curettage and bhcg in 48h

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29
Q

Risk of miscarriage at 30y/o

A

10%

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30
Q

What is normal variability

A

5-25bpm

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31
Q

Which test predicts preterm birth between 22 and 35 weeks of gestation

A

foetal fibronectin

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32
Q

What constitutes normal semen analysis
Vol
pH:
Sperm concentration: million/ml
Total sperm/ejaculate: million
Total motility: %
Progressive motility: %
Vitality: %
Morphology: %

A

Vol 1.5 ml
pH: 7.2
Sperm concentration: 15 million/ml
Total sperm/ejaculate: 39 million
Total motility: 40%
Progressive motility: 32%
Vitality: 58%
Morphology: 4%

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33
Q

Fraser’s Law - describe

A

Dr should encourage girl age 16 or less to tell her parents she is starting contraception.

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34
Q

Patient seen after hysterectomy with Hb 6.2g/dl, hematocrit 29%, Blood pressure 80/90, pulse 109 bpm. Cause?

A

Internal bleeding

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35
Q

5 weeks since last menses. Patient presents with mild vaginal bleeding. US shows no evidence of intrauterine pregnancy. beta Hcg is 400 IU and after 48hrs beta Hcg is 700 IU . What is the most likely diagnosis?

A

Normal pregnancy (?)

HCG has increased by >63% in 48h
Repeat scan when HCG >1500

(If it falls by 50% then likely failing)

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36
Q

Patient with 9cm dilated cervix and intact membranes. CTG is reactive since the last exam 2hrs ago. What is the next action?

A

Leave for another 2hr
(4h between assessments)

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37
Q

Postpartum haemorrage after vaginal delivery. pharmaceutically failed to stop bleed. What is the first surgical step to stop bleeding?

A

Intrauterine balloon tamponade

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38
Q

Medical treatment of ectopic pregnancy

A

Methotrexate

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39
Q

Early pregnancy with irregular cycle with vaginal bleeding. Urine pregnancy test is positive. Her LMP 5 weeks ago. Transvaginal ultrasound shows CRL 6 mm and lntrauetrine gestational sac with fetal pole. There is no fetal heart beat. What is the next appropriate step?

A

Repeat U/S after 7-10 days
When no FH found, CRL must be >7mm

To diagnose miscarriage
CRL >7mm + no FH
Gestation sac > 25mm (with no yolk sac)

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40
Q

Kleihauer test is used to determine ?

A

Fetomaternal haemorrhage

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41
Q

How do you calculate Apgar score?

A

(score is 0-10)

Appearance: 1 peripheral cyanosis
*Pulse: 1<100 / 2 >100
Grimace: 1 weak cry
Activity/tone: 1 some flexion
Respiration: 1slow irregular breath

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42
Q

Semen analysis
Vol 2.5ml
pH: 7.3
Sperm concentration: 32 million/ml
Progressive motility: 60%
Morphology: 5%
Liquefaction time 30 minutes
Interpretation?

A

Normal semen analysis

Minimum parameters:
Vol 1.5 ml
pH: 7.2
Sperm concentration: 15 million/ml
Progressive motility: 32%
Morphology: 4%

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43
Q

Where is cell-free fetal DNA in NIPT derived from

A

The placenta - trophoblast

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44
Q

CTG
Baseline 120-130
Normal variability
Few accelerations
Typical variable decelerations for >90 mins
Classification and management?

A

Suspicious CTG - observe closely

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45
Q

Teenager wants abortion without parents’ knowledge - which law/principle should be followed?

A

Fraser’s Law

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46
Q

Wernicke-Korsakoff syndrome Deficiency disease of vitamin?

A

Vitamin B1

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47
Q

What is affected in Horner syndrome?

A

Loss of sympathetic supply

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48
Q

Urodynamics interpretation
Increase in PVES and PDET
PABD stays same

A

Detrusor overactivity
(increased detrusor pressure)

Contrast with stress incontinence
Increased abdominal pressure (no detrusor activity)

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49
Q

Placement of cup during ventose delivery when the neck is flexed

A

Saggital

50
Q

Pregnancy related nausea and vomiting uses PUQE index. What is the maximum score?

A

15

51
Q

The most common dermatitis in pregnancy

A

Polymorphic (PUPP)

+ Obstetric Cholestasis

52
Q

Vitamin E toxicity causes?

A

Haemorrhage

53
Q

RTA with abdominal pain at term Rh negative. Management (specific)?

A

Anti D 500 iu

54
Q

Incomplete early miscarriage, bleeding PV, refuse surgical intervention. Alternative main drug for medical management?

A

misoprostol

55
Q

How long should patients with hyperemesis gravidarum have LMWH for?

A

Until discharge only

56
Q

CTG normal, then changes to variability <5bpm Next management?

A

FBS

57
Q

What depression screening questionnaire is frequently used during pregnancy?

A

Edinburgh Postnatal Depression Scale

58
Q

CT KUB with blocked ureter in patient with history of cervical cancer

A

Ureteric obstruction

59
Q

A 25-year-old woman presented to an early pregnancy unit with mild vaginal bleeding after 5 week’s amenorrhea. There is history of irregular menses. Ultrasound shows no evidence of intrauterine pregnancy. Beta hCG is 400 IU/l and beta hCG after 48hrs later is 700 IU/l. What is the most likely diagnosis?

A

Early normal pregnancy

HCG <700 can’t see on USS

60
Q

Which is the most common cause of the premature ovarian failure?

A

Idiopathic

61
Q

Telogen Effluvium (hair loss) is more pronounced in what stage of pregnancy?

A

After delivery

62
Q

absent clitoris and normal labia majora. What type of FGM is this?

A

Type 1 FGM

1 - clitoris removed
2 - clitoris + labia minora +/- majora
3 - infibulation (narrowed Introitus)
4 - everything else (e.g. a nick/burn)

63
Q

You see a patient who is 35 weeks pregnant in your day assessment unit. She presents with itching… more on the area of the abdominal striae. Lab results given which showed normal ALP, normal bilirubin levels. Diagnosis?

A

Polymorphic eruption of pregnancy

64
Q

What part of the uterus is destroyed in ablation for menorrhagia?

A

Basal layer of the endometrium

65
Q

What is the new non invasive prenatal diagnostic test of cell-free fetal DNA of maternal blood derived from?

A

Placental trophoblast

66
Q

What is the most common site of endometriosis

A

Ovary

67
Q

What is the most common form of fibroid degeneration?

A

Hyaline

68
Q

31 yr old c/o subfertility for 2yrs , no medical problem , BMI 38kg/m2 , hormone result : FSH 8
LH 18
progesterone 4 nm m/l
E2 198
Most appropriate management

A

Weight loss

69
Q

25 y/o had lscs at term for breech presentation with spinal anesthesia After what time you start low dose molecular heparin(LMWH)

A

?6 hours

70
Q

Patient has a renal calculus, where is referred pain often felt?

A

Lumbar region

71
Q

What is the process for a direct Coombs test?
Who gets this test?

A

Patient RBCs + anti-human globulin –> agglutination
Done on a newborn with jaundice
?haemolytic anaemia

72
Q

What is the process for indirect Coombs test?
Who gets this test?

A

Patient serum + add test RBCs & anti-human globulin –> agglutination

Identifies free floating antibodies

Shows mother has antibodies to foetal RBCs and is sensitised

73
Q

Woman with 3 previous children that had jaundice. She is O neg and her new partner in this pregnancy is A + with phenotype: CDe/cde.

A

? I think A pos or A negative

as ‘CDe’ is small chance of recessive

74
Q

What is the risk of repeat ectopic after laparoscopy for ectopic?

A

18%

75
Q

Pregnant patient develops a goitre, which nerve has been injured or compressed?

A

Recurrent laryngeal nerve

76
Q

A patient with pre-eclampsia has an intracranial haemorrhage, which artery is affected?

A

Middle cerebral artery

77
Q

ECG long QT
spasms
paraesthesia
Dx

A

Hypocalcaemia

78
Q

Blood group O+
What antibodies do they have

A

AB antibodies

79
Q

What is CRISPR

A

enzyme that cleaves DNA sequences

80
Q

What gestational age are the two doses of anti D given at?

A

28 + 34 weeks

81
Q

Lack of which vitamin causes pellagra?

A

Niacin (B3)

82
Q

CtG picture G2P1 , term , mid wife noticed ctg showing variable deceleration for last 20 minutes rest ctg was reactive normal , p/v exm os 6 cm. Next step?

A

This may be a suspicious CTG
BUT doesn’t say whether there are ‘concerning characteristics’ of decels or whether with >/< 50% of contractions

Indications for FBS
1. Pathological CTG in labour (cervix dilated >3 cm)
2. Suspected acidosis in labour (cervix dilated >3 cm)

83
Q

What is a good source of vitamin K

A

Green leafy vegetables

84
Q

Intraoperative cell salavage blood loss during cesarean section (%)

A

20%

85
Q

36h post op TAH, patient has a fever of 38 degrees. Why?

A

Physiological cytokine release

86
Q

What is the shelf life of whole blood

A

7 weeks

87
Q

What bile acid level is considered harmful to foetus and indication for delivery

A

> 40

88
Q

What causes hypotension after an anaesthesia?

A

Blockade of preganglionic sympathetic nerves

89
Q

HbAS identified at booking - what is the diagnosis?

A

Sickle cell trait

90
Q

Baby born with intestines extending uncovered through a hole which is next to the umbilicus

A

Gastroschisis

91
Q

Baby born with intestines extending covered through a hole in the umbilicus

A

Omphalocele

92
Q

What are the two diagonal lines on a partograph?

A

Alert line
Action line

93
Q

Vulval ulcers in someone who has not been sexually active?

A

Behchets
Oral, genital ulcers, anterior uveitis
An autoimmune vasculitis

94
Q

DVT in previous pregnancy
Now 18/40 pregnant
Mx?

A

Start LMWH now

95
Q

In an ongoing PPH, what should the fibrinogen level be maintained above?

A

2-4 micro L

96
Q

What is an elevated FFN

A

> 50

FFN can be done between 22 - 35 weeks gestation

97
Q

How many ml lidocaine can be given with adrenaline?

A

7mg / kg

98
Q

What deficiency in hyperemesis gravidarum is dangerous?

A

B1 (thiamine) causes wercicke’s encephalopathy

99
Q

Which vitamins break down homocysteine (an amino acid).
Without the vitamin you get high homocysteine

A

Folic acid
B12
B6

100
Q

Caput medusi are due to engorgement of what vessel?

A

Umbilical vein

101
Q

What speed is a CTG print out?

A

1cm per minute

102
Q

Young girl with history of dysfunctional uterine bleeding. FBC + which other test?

A

Clotting profile

103
Q

What is a normal post void bladder scan ?

A

<200mls

104
Q

Missed COCP on day 12. What is your advice?

A

You need 7 active pills to be taken

1st week - emergency contraception
*2nd week (D8-14) - take extra pill only
3rd week - omit pill free interval

105
Q

What are Filshie clips, used in tubal ligation, made of?

A

titanium

106
Q

1 miscarriage, 1 still birth, 1 twin gest live birth at 36 weeks. How do you describe their gravidity and parity

A

G3P3 (?)

3 pregnancies
3 births / stillbirths

107
Q

HCG measured 48h apart
What change indicates
1 - pregnancy unlikely to continue
2 - need for repeat review
3 - Likely intrauterine pregnancy

A

1 fail - decrease 50% - UPT in 14 days
2 - in between
3 ok - Increase by 63% - Scan when HCG >1500

108
Q

According to RCOG, which progesterone levels suggest:
failing
intrauterine pregnancy

A

failing <20
intrauterine >60

109
Q

Describe
Septate
Bicornuate
Didelphus

A

Septate - septum middle, convex outer
Bicornuate - two horns of uterus, heart shaped outer
Didelphus - complete duplication of uterine horns AND cervix

110
Q

Describe Placenta
Succentiurate
Velamentous
Battledore

A

Succentiurate LOBE (extra lobe)
Velamentous - in the membranes
Battledore - insertion at the outer edge

111
Q

What is the definition of a minor PPH

A

500-1000ml with no signs of shock

112
Q

What drug is given to treat severe pre eclampsia in an asthmatic patient

A

Hydralazine

113
Q

Below which centile of symphysis fundal height should women be referred for serial growth scans ?SGA

A

Below 10th centile

114
Q

Prior to hysterectomy, patient is on POP, what additional contraception will you advise?

A

Barrier
(not sure why)

115
Q

At what point can someone who had gestational trophoblastic disease begin taking COCP?

A

When the BHCG returns to normal and is not rising

116
Q

How many weeks after a complete miscarriage should a pregnancy test be completed?

A

3 weeks (NHS website)

117
Q

What does fibronectin bind to?

A

Integrins
(which are membrane receptors)

118
Q

Deficiency of which electrolyte can cause paralytic ileus?

A

Potassium

119
Q

At what gestation can placenta praaevia diagnosis be confirmed

A

32 weeks (?)

120
Q

A patient has been on oestrogen only HRT for 5 years. What is their breast cancer risk?

A

Low risk or no risk (?)

P1EXAM (27 decks)

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