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Difficult Past Questions Flashcards

1
Q

Vitamin deficiency in hyperemesis gravidarum

A

Thiamine (B1) deficiency

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2
Q

14 year old primary with amenorrhoea + ejection systolic murmur

A

Turner’s

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3
Q

Cyclical pain, no heavy menstrual bleed, never sexually active

A

Ovarian cyst

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4
Q

What do you test for in Hep B infection antenatally?

A

HBsAg

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5
Q

At antenatal check, woman with BP 150/90, what would you do?

A

Admit and assess

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6
Q

Women with previous GDM- what is the best way to investigation her blood glucose?

A

OGTT at 24-28 weeks

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7
Q

What type of contraception can increase risk of osteoporosis?

A

Depo-Provera

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8
Q

Women with excessive vomiting, under what circumstance would you admit her?

A

Ketonuria

also 5% weight loss and can’t tolerate oral antiemetics

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9
Q

Infection causing azoospermia

A

Mumps orchitis

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10
Q

Someone comes in at 28w with a Hb of 10.5 what would you do?

A

Oral iron

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11
Q

Women with menopausal symptoms, hysterectomised, does not want to take oral tablets

A

Transdermal oestrogen HRT

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12
Q

Painful multiple lesions on labia

A

Herpes

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13
Q

Mother with stillborn baby, generalized oedematous when born, mother had fever at 18w with rash on trunk

A

Parvovirus B19

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14
Q

Mother being prepared for CS, sudden tingling around her mouth?

A

Spinal block

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15
Q

When should lose Moro Reflex?

A

4 months

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16
Q

When should lose asymmetrical tonic neck reflex?

A

7 months

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17
Q

When should lose palmar grasp reflex?

A

6 months

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18
Q

When should lose upgoing plantars?

A

12 months

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19
Q

What is rooting reflex?

A

Newborn infant will turn its head toward anything that strokes its cheek or mouth,

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20
Q

When should lose rooting reflex?

A

4 months

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21
Q

Strawberry tongue

A

Scarlet Fever

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22
Q

Pruritus ani worse at night

A

Threadworm

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23
Q

Treatment for pruritus ani worse at night

A

Mebendazole

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24
Q

Impetigo treatment

A

Mild and localised: fucidic acid for 5 days

Widespread/bullous: flucloxacillin for 7 days

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25
Q

Scabies treatment

A

Permethrin cream

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26
Q

What age would refer if can’t sit without support?

A

8 months (normally by 6)

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27
Q

What age would refer if can’t walk?

A

18 months (normally by 15)

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28
Q

What age would refer if can’t hop on one leg?

A

5 years (normally by 4)

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29
Q

What age would refer if can’t pincer grip?

A

12 months (normally by 10)

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30
Q

What age would refer if can’t smile?

A

8 weeks (normally by 6)

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31
Q

Benign tumour which responds well to NSAIDs initially

A

Osteoid osteoma

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32
Q

Posterior fossa tumour

A

Pilocytic astrocytoma or medulloblastoma (answer says medulloblastoma)

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33
Q

Rash that started from behind the ears and spread to trunk, parents are vegetarians and kid goes to school in north London

A

Measles

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34
Q

Scaphoid abdomen

A

Diaphragmatic hernia

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35
Q

When to refer somatisation to CAMHS?

A
  • Stressors hard to relieve
  • Serious family dysfunction
  • Pain impairs functioning
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36
Q

Diagnosed bipolar disorder – sudden renal failure, what do you check?

A

Lithium levels

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37
Q

Someone is brought in by their mother to A&E and appears psychotic – what section would you put them under?

A

Section 4

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38
Q

Treatment of dystonia

A

Procyclidine

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39
Q

Someone who lost her husband 7 months ago and started hearing voices of him saying to join him a month ago

A

Abnormal grief response

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40
Q

78yo guy has issues with organization, troubles with understanding words

A

Frontotemporal dementia

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41
Q

Learning Disability criteria

A
  1. IQ < 70 (normal = 100)
  2. Impact on daily living
  3. Present before age 18
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42
Q

Who would you refer a schizophrenic patient to if they are being discharged and needs support in the community regarding treatment?

A

Community psychiatric nurse

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43
Q

Drug that acts on 5HT receptors

A

LSD/MDMA

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44
Q

Meaning of CIN II

A

Moderate dyskariosis

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45
Q

20-week antenatal scan, which is best description:

  • Tests nuchal translucency
  • Least amount of radiation
  • 2D with foetal biometry
  • Multiple pregnancies
A

2D with foetal biometry

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46
Q

Leading cause of maternal death in UK

A

Heart disease = pregnancy until 6 months postpartum

Suicide = 1 year postpartum

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47
Q

Cause of inspiratory stridor since birth

A

Laryngomalacia

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48
Q

Kid takes 4 benzodiazepine tablets 4 hours ago. Currently asleep but was GCS 15 a few hours ago. Next step?

A

Admit for monitoring

IV flumenazil reverses CNS depression

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49
Q

Kid recently started solids, now constipated. No faecal masses felt in abdomen.

A

Increase fluid intake

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50
Q

Old woman is anxious as increasingly forgetful – thinks she has dementia

A

Depression

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51
Q

Treatment of nappy rash with satellite lesions

A

Clotrimazole

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52
Q

Treatment of nappy rash with flexural sparing

A

Zinc barrier cream

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53
Q

2 foetal poles, one gestational sac = what type of twin?

A

Monoamniotic

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54
Q

Posterior rib fractures

A

Non-accidental injury

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55
Q

Commonest type of endometrial cancer

A

Endometrial adenocarcinoma

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56
Q

Yellow-green vaginal discharge and pain

A

Trichomonas vaginalis

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57
Q

Child complains of unusual smell. Then “spaces out”. After she’s very drowsy and sleeps for a few hours. Can’t remember what happened

A

Focal seizure

58
Q

7yo who refuses to HW and plays Minecraft on iPad. Parents worried

A

Normal behaviour for age (?)

59
Q

UTI treatment first trimester

A
  1. Nitrofurantoin

2. Cefalexin

60
Q

First test you do in amenorrhoea

A

b-hCG

61
Q

Test to confirm premature ovarian failure

A

Increased FSG on 2 samples six weeks apart

62
Q

Commonest cause of azoospermia

  • Mumps
  • Hx of testicular torsion
  • Varicocele
A

Varicocele

63
Q

Post-menopausal woman with a PV bleed. What ix should you do?

A

Outpatient US with endometrial biopsy

64
Q

Asymptomatic woman, nulliparous, found to have a 5.4cm unilocular ovarian cyst on US, no fhx. Mgmt/Ix?

  • USS guided cyst aspiration
  • Laparoscopic removal of cyst
  • Discharge and safety-net
  • Rearrange USS in 3 months and Ca125 follow-up
A

Rearrange USS in 3 months and Ca125 follow-up

65
Q

What causes increased urinary volume and frequency in the first trimester?

  • Increased GFR
  • Pressure of uterus on bladder
  • Glycosuria
A

Increased GFR

66
Q

SSRI effect on newborn

A

Persistent Pulmonary Hypertension of the Newborn

67
Q

Woman with Nexplanon. Most likely reason for wanting to change contraceptive?

  • Weight gain
  • Acne
  • Mood swings
  • Irregular bleeding
A

Irregular bleeding

68
Q

Woman with a slow growing painless lesion on labia

A

Genital warts

69
Q

Woman with tender lump inside her vagina.

A

Bartolin’s cyst

70
Q

Menopause option: woman with premature ovarian failure, wants to have periods

A

COCP

71
Q

Small slow-growing lesion on labia, pregnant lady

A

Genital Warts (pregnancy causes them to grow)

72
Q

Kid with history of anal fissure - what is your first course of action?

A

Inspect anal region

73
Q

A-level student has recently come back from Nigeria, with symptoms of jaundice, mild anaemia and fever with malaise and arthralgia.

A

Malaria

74
Q

Kid has pain in outer ear, ear was protruding outwards, and there was a lump behind his ear.

A

Mastoiditis

75
Q

Kid with cervical lymphadenopathy, fever, sore throat, red tongue with white spots. What does she have?

A

Scarlet Fever (strawberry tongue)

76
Q

4 month old, about to have 3 batch of primary vaccinations. Which would be a complete contraindication to having the vaccine?

  • Confirmed history of pertussis as a baby
  • Currently ill with a fever of 38.5
  • Got a rash at site of last vaccination
  • Severe cow’s milk allergy,
A

Currently ill with a fever of 38.5

77
Q

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

A

Mebendazole = treats threadworm

78
Q

Kid with URTI and generalised abdo tenderness

A

Mesenteric adenitis

79
Q

Baby was born at 41 weeks via emergency C-section due to foetal distress. Needed ventilation straight away. X-ray showed hyper inflated lungs with areas of consolidation.

A

Meconium aspiration

80
Q

Baby born at 37 weeks, via forceps. Showing signs of resp distress. CXR shows areas of consolidation throughout.

A

Group B Strep

81
Q

80 year old man with new onset dementia, needs MRI but refuses. You need someone to make decision for him

  • Talk to family with his permission
  • Ask independent mental health advocate
A

Ask independent mental health advocate

82
Q

Risk of schizophrenia if one parent has it

A

10% (twin = 50%)

83
Q

What is high in anorexia nervosa?

A

Growth hormone

84
Q

Man with treatment resistant schizophrenia on clozapine, recently stopped smoking. High level of clozapine now. Most likely consequence?

A

Seizures (agranulocytosis is not dose-dependent!)

85
Q

Man perceives objects to be smaller than they are

A

Micropsia

86
Q

Technical term for feel insects under skin

A

Formication

87
Q

Woman is pregnant and HIV negative at booking but her partner is HIV positive - what do you do?

A

Nothing

88
Q

Results show azoospermia. How should they be managed?

  • IVF
  • Egg donation
  • ICSI
  • IUI
A

ICSI = Intracytoplasmic Sperm Injection

89
Q

Definition of onset of active first stage of labour

A

Cervix 4cm dilated and regular contractions

90
Q

Tamoxifen increases risk of this cancer

A

Endometrial

91
Q

3 months old baby with signs of HF, systolic murmur that radiates over the precordium

A

VSD

92
Q

What is the most important thing to look at in follow up of HSP?

A

Urine protein and RBCs

93
Q

6 year old child with 24 hour history of left peri-orbital swelling. Had an upper respiratory tract infection last week. Left proptosis, visual acuity was normal and had a fever of 38.9. What is the best diagnostic investigation?

A

CT of nasal orbits

94
Q

Child in A&E with asthma attack, was given puffs of salbutamol. Now has a quiet chest, what do you do next?

A

Call for senior help

95
Q

Child with fever, white exudate on one tonsil

A

Quinsy (peritonsillar abscess)

96
Q

Mother complains her young child is a fussy eater. She eats soft foods and drinks a lot of milk. Also has been feeling tired recently

A

Iron deficiency anaemia

97
Q

Child suffers from fever. The fever disappears but she has now developed a blanching rash on trunk. She subsequently has febrile convulsions.

A

HHV6 (roseola infantum)

98
Q

Kid with delayed milestones in language, GP clicked his fingers and she turned to look, what’s the next step?

  • Refer for hearing assessment
  • Refer to SALT
  • Refer for developmental assessment
A

Refer for hearing assessment

99
Q

Hypochloraemic hypokalaemic pH shown, with some clinical information. What is the initial management for it? -Correct electrolyte imbalance

  • Surgical consult
  • Abdominal USS
A

Correct electrolyte imbalance

100
Q

3 year old kid with unilateral nasal discharge with bleeding and crust

A

Foreign body insertion

101
Q

Unwell child where chest was clear, had a fever. Lost weight recently. What do you do next?

  • CXR
  • Urine dip,
  • Glucose
  • ABG
A

Glucose (always go with ABC DEFG approach as that’s what you do FIRST)

102
Q

Neonate with some cardio problem. Systolic murmur loudest at the left sternal edge 2/6

A

VSD

103
Q

Hip pain on exercise and climbing stairs. Prolonged history, otherwise well.

  • Perthes disease
  • Osgood-schlater
  • Septic arthritis
A

Perthes Disease

104
Q

Blue dots on cervix

A

Endometriosis (answers say Nabothian Cysts)

105
Q

Sudden abdo pain, well child, something indentable on the L lower quadrant

A

Answer says Wilm’s Tumour

106
Q

Kid with functional abdo pain associated with school. Best management:

  • Encourage to go to school and come back when tummy starts to hurt
  • Have her schoolwork sent home whilst she is having pains
  • Change school
  • Make her go to school regardless of pains
  • Give her home tutoring
A

Encourage to go to school and come back when tummy starts to hurt

107
Q

4 year old girl with a high fever that was followed by a rash which has small white dots on a red base. What is the most likely Dx?

A

Could be Roseola (fever first, then rash)

108
Q

14 year old kid who thieves, gets into fights (basically conduct disorder). What is first-line management

  • Multisystemic (family) therapy
  • CBT
  • DBT
  • Psychodynamic therapy
A

Multisystemic (family) therapy

109
Q

Uncle gets TB, kid lives with him. Mantoux test showed a number between 10-14mm for the result. What should you do?

  • Watch and wait
  • Give isoniazid prophylaxis
  • Start anti-TB treatment
  • Give BCG vaccine
A

Start anti-TB treatment (>5mm is positive if have TB contacts)

110
Q

Definitive diagnostic test for precocious puberty?

  • Bone age
  • Gonadotropin stimulation test
  • MRI scan of pituitary fossa
A

Gonadotropin stimulation test (apparently…)

111
Q

Kid with hemiplegic weakness and brisk reflexes, what area of the brain is affected?

  • Basal ganglia
  • Pyramidal tracts
  • Motor cortex
  • Cerebellum
  • Internal capsule
A

Motor cortex

112
Q

Kid with rough rash on face & trunk, flushed face. No rash around mouth

A

Scarlet Fever (sandpaper rash)

113
Q

HIV with undetectable viral load. What is contraindicated in labour?

  • Forceps
  • Ventouse
  • Foetal blood sampling
  • C-section
A

Foetal blood sampling

114
Q

Woman with rupture of membranes and painless bleeding

A

Vasa praevia

115
Q

17yr old girl wanting Emergency contraception more than 5 days after unprotected sex

A

Copper IUD

116
Q

Contraception used soon after giving birth

A

POP immediately (IUS after 4 weeks)

117
Q

Baby’s head comes out but then goes back in

A

Shoulder dystocia

118
Q

Woman had some intrauterine growth and endometrial thickness

A

Fibroids

119
Q

Pregnant woman in early pregnancy with depression and anxiety on sertraline. What do you do?

  • Stop sertraline
  • Continue sertraline
  • Prescribe high-dose folic acid
  • Reduce the dose
  • Amitryptylline
A

Continue sertraline

120
Q

Post partum haemorrhage with high BP

  • Carboprost
  • Misoprostol
  • Ergometrine
  • Syntocinon
A

Syntocinon (ergometrine contraindicated in HTN)

121
Q

Foetus with transverse lie, recent SROM – now CTG shows foetal distress

A

Cord Prolapse

122
Q

What’s the management for DVT risk in a pregnant woman who’s coming in for a planned cesarean?

  • LMWH
  • LMHW and Ted stockings
  • Ted stockings
  • Warfarin
  • Aspirin and Ted stockings
A

LMHW and Ted stockings

123
Q

Woman with raised testosterone and LH:FSH ratio 2:1

A

PCOS

124
Q

Woman with blocked tubes on hysterosalpingogram, what treatment should you do for fertility?

  • IVF
  • IUI
  • ICSI
A

IVF

125
Q

Heavy periods in a girl not sexually active. What do you give her?

  • COCP
  • Mefenamic acid
  • Transexamic acid
A

Transexamic acid

126
Q

Poorly controlled diabetic mother, her newborn has an abnormal asymmetric Moro reflex - what’s wrong?

A

Brachial plexus injury

127
Q

Woman on COCP, has missed 6th and 7th day pill, had unprotected sex two days ago, her urine pregnancy is clear. What to do?

A

Emergency contraception (also take most recent missed pill and extra precautions in next 7 days)

128
Q

Woman with endometriosis, had laparoscopic adhesiolysis - had a whole range of sx - high CRP, low Hb, constipation, bowel sounds absents - what’s happened?

A

Perforation

129
Q

Woman with offensive smelly lochia day 2 post-partum, had had some high vaginal swabs.

  • Reassure and discharge
  • Await swab results
  • Give antibiotics
  • Abdo USS
A

Give antibiotics

130
Q

70yo with 2 post-menopausal bleeds, TVUS shows 6mm endometrium and 3 cm simple ovarian cyst. Next step?

  • Ca125
  • Diagnostic laparoscopy
  • Pipelle
A

Ca125

131
Q

MMSE cut-offs

A

24-30: normal
19-23: mild
10-18: moderate
0-9: severe

<21: increased dementia

132
Q

Some girl with anorexia was admitted and she started eating and stuff. Then she gets muscle spasms, and abdominal pain. What electrolyte most deranged?

A

Calcium = muscle spasms

133
Q

Someone else kicking off and de-escalation has failed, what drugs?

  • Lorazepam
  • Lorazepam + haloperidol
  • Haloperidol
A

Lorazepam

134
Q

Girl drops out of uni, goes back home lives with mother and blames mother for poisoning her

  • Paranoid type disorder
  • Schizoid personality disorder
  • Acute psychosis
A

Acute psychosis

135
Q

Woman blushes in public

A

Social phobia

136
Q

Woman has been spending loads of money, lots of energy, little sleep, going on for 6 weeks but not affecting her work (although feels more imaginative)

A

Hypomania

137
Q

Dude with LBD, given a drug that makes him worse

A

Haloperidol

138
Q

People with learning disabilities coming in with carers/families and their carers/families disagreeing with the doctor’s plan – what would you do first?

A

ALWAYS assess capacity- everyone is assumed to have capacity until proven otherwise

139
Q

Dilated pupils, urinary retention, obs normal - cause of overdose?

  • TCA
  • Benzos
  • Opioids
  • SSRI
A

Benzos

140
Q

What do you monitor with lithium?

A

Lithium, TFTs, U&E

141
Q

Definitive diagnostic test of precocious puberty

A

GnRH Stimulation test (pre-pubertal respond poorly to GnRH, precocious respond well)

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