Difficult Past Questions Flashcards
Vitamin deficiency in hyperemesis gravidarum
Thiamine (B1) deficiency
14 year old primary with amenorrhoea + ejection systolic murmur
Turner’s
Cyclical pain, no heavy menstrual bleed, never sexually active
Ovarian cyst
What do you test for in Hep B infection antenatally?
HBsAg
At antenatal check, woman with BP 150/90, what would you do?
Admit and assess
Women with previous GDM- what is the best way to investigation her blood glucose?
OGTT at 24-28 weeks
What type of contraception can increase risk of osteoporosis?
Depo-Provera
Women with excessive vomiting, under what circumstance would you admit her?
Ketonuria
also 5% weight loss and can’t tolerate oral antiemetics
Infection causing azoospermia
Mumps orchitis
Someone comes in at 28w with a Hb of 10.5 what would you do?
Oral iron
Women with menopausal symptoms, hysterectomised, does not want to take oral tablets
Transdermal oestrogen HRT
Painful multiple lesions on labia
Herpes
Mother with stillborn baby, generalized oedematous when born, mother had fever at 18w with rash on trunk
Parvovirus B19
Mother being prepared for CS, sudden tingling around her mouth?
Spinal block
When should lose Moro Reflex?
4 months
When should lose asymmetrical tonic neck reflex?
7 months
When should lose palmar grasp reflex?
6 months
When should lose upgoing plantars?
12 months
What is rooting reflex?
Newborn infant will turn its head toward anything that strokes its cheek or mouth,
When should lose rooting reflex?
4 months
Strawberry tongue
Scarlet Fever
Pruritus ani worse at night
Threadworm
Treatment for pruritus ani worse at night
Mebendazole
Impetigo treatment
Mild and localised: fucidic acid for 5 days
Widespread/bullous: flucloxacillin for 7 days
Scabies treatment
Permethrin cream
What age would refer if can’t sit without support?
8 months (normally by 6)
What age would refer if can’t walk?
18 months (normally by 15)
What age would refer if can’t hop on one leg?
5 years (normally by 4)
What age would refer if can’t pincer grip?
12 months (normally by 10)
What age would refer if can’t smile?
8 weeks (normally by 6)
Benign tumour which responds well to NSAIDs initially
Osteoid osteoma
Posterior fossa tumour
Pilocytic astrocytoma or medulloblastoma (answer says medulloblastoma)
Rash that started from behind the ears and spread to trunk, parents are vegetarians and kid goes to school in north London
Measles
Scaphoid abdomen
Diaphragmatic hernia
When to refer somatisation to CAMHS?
- Stressors hard to relieve
- Serious family dysfunction
- Pain impairs functioning
Diagnosed bipolar disorder – sudden renal failure, what do you check?
Lithium levels
Someone is brought in by their mother to A&E and appears psychotic – what section would you put them under?
Section 4
Treatment of dystonia
Procyclidine
Someone who lost her husband 7 months ago and started hearing voices of him saying to join him a month ago
Abnormal grief response
78yo guy has issues with organization, troubles with understanding words
Frontotemporal dementia
Learning Disability criteria
- IQ < 70 (normal = 100)
- Impact on daily living
- Present before age 18
Who would you refer a schizophrenic patient to if they are being discharged and needs support in the community regarding treatment?
Community psychiatric nurse
Drug that acts on 5HT receptors
LSD/MDMA
Meaning of CIN II
Moderate dyskariosis
20-week antenatal scan, which is best description:
- Tests nuchal translucency
- Least amount of radiation
- 2D with foetal biometry
- Multiple pregnancies
2D with foetal biometry
Leading cause of maternal death in UK
Heart disease = pregnancy until 6 months postpartum
Suicide = 1 year postpartum
Cause of inspiratory stridor since birth
Laryngomalacia
Kid takes 4 benzodiazepine tablets 4 hours ago. Currently asleep but was GCS 15 a few hours ago. Next step?
Admit for monitoring
IV flumenazil reverses CNS depression
Kid recently started solids, now constipated. No faecal masses felt in abdomen.
Increase fluid intake
Old woman is anxious as increasingly forgetful – thinks she has dementia
Depression
Treatment of nappy rash with satellite lesions
Clotrimazole
Treatment of nappy rash with flexural sparing
Zinc barrier cream
2 foetal poles, one gestational sac = what type of twin?
Monoamniotic
Posterior rib fractures
Non-accidental injury
Commonest type of endometrial cancer
Endometrial adenocarcinoma
Yellow-green vaginal discharge and pain
Trichomonas vaginalis
Child complains of unusual smell. Then “spaces out”. After she’s very drowsy and sleeps for a few hours. Can’t remember what happened
Focal seizure
7yo who refuses to HW and plays Minecraft on iPad. Parents worried
Normal behaviour for age (?)
UTI treatment first trimester
- Nitrofurantoin
2. Cefalexin
First test you do in amenorrhoea
b-hCG
Test to confirm premature ovarian failure
Increased FSG on 2 samples six weeks apart
Commonest cause of azoospermia
- Mumps
- Hx of testicular torsion
- Varicocele
Varicocele
Post-menopausal woman with a PV bleed. What ix should you do?
Outpatient US with endometrial biopsy
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
Rearrange USS in 3 months and Ca125 follow-up
What causes increased urinary volume and frequency in the first trimester?
- Increased GFR
- Pressure of uterus on bladder
- Glycosuria
Increased GFR
SSRI effect on newborn
Persistent Pulmonary Hypertension of the Newborn
Woman with Nexplanon. Most likely reason for wanting to change contraceptive?
- Weight gain
- Acne
- Mood swings
- Irregular bleeding
Irregular bleeding
Woman with a slow growing painless lesion on labia
Genital warts
Woman with tender lump inside her vagina.
Bartolin’s cyst
Menopause option: woman with premature ovarian failure, wants to have periods
COCP
Small slow-growing lesion on labia, pregnant lady
Genital Warts (pregnancy causes them to grow)
Kid with history of anal fissure - what is your first course of action?
Inspect anal region
A-level student has recently come back from Nigeria, with symptoms of jaundice, mild anaemia and fever with malaise and arthralgia.
Malaria
Kid has pain in outer ear, ear was protruding outwards, and there was a lump behind his ear.
Mastoiditis
Kid with cervical lymphadenopathy, fever, sore throat, red tongue with white spots. What does she have?
Scarlet Fever (strawberry tongue)
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,
Currently ill with a fever of 38.5
Perianal itching especially at night. What’s the best treatment option?
Mebendazole = treats threadworm
Kid with URTI and generalised abdo tenderness
Mesenteric adenitis
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.
Meconium aspiration
Baby born at 37 weeks, via forceps. Showing signs of resp distress. CXR shows areas of consolidation throughout.
Group B Strep
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
Ask independent mental health advocate
Risk of schizophrenia if one parent has it
10% (twin = 50%)
What is high in anorexia nervosa?
Growth hormone
Man with treatment resistant schizophrenia on clozapine, recently stopped smoking. High level of clozapine now. Most likely consequence?
Seizures (agranulocytosis is not dose-dependent!)
Man perceives objects to be smaller than they are
Micropsia
Technical term for feel insects under skin
Formication
Woman is pregnant and HIV negative at booking but her partner is HIV positive - what do you do?
Nothing
Results show azoospermia. How should they be managed?
- IVF
- Egg donation
- ICSI
- IUI
ICSI = Intracytoplasmic Sperm Injection
Definition of onset of active first stage of labour
Cervix 4cm dilated and regular contractions
Tamoxifen increases risk of this cancer
Endometrial
3 months old baby with signs of HF, systolic murmur that radiates over the precordium
VSD
What is the most important thing to look at in follow up of HSP?
Urine protein and RBCs
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?
CT of nasal orbits
Child in A&E with asthma attack, was given puffs of salbutamol. Now has a quiet chest, what do you do next?
Call for senior help
Child with fever, white exudate on one tonsil
Quinsy (peritonsillar abscess)
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
Iron deficiency anaemia
Child suffers from fever. The fever disappears but she has now developed a blanching rash on trunk. She subsequently has febrile convulsions.
HHV6 (roseola infantum)
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
Refer for hearing assessment
Hypochloraemic hypokalaemic pH shown, with some clinical information. What is the initial management for it? -Correct electrolyte imbalance
- Surgical consult
- Abdominal USS
Correct electrolyte imbalance
3 year old kid with unilateral nasal discharge with bleeding and crust
Foreign body insertion
Unwell child where chest was clear, had a fever. Lost weight recently. What do you do next?
- CXR
- Urine dip,
- Glucose
- ABG
Glucose (always go with ABC DEFG approach as that’s what you do FIRST)
Neonate with some cardio problem. Systolic murmur loudest at the left sternal edge 2/6
VSD
Hip pain on exercise and climbing stairs. Prolonged history, otherwise well.
- Perthes disease
- Osgood-schlater
- Septic arthritis
Perthes Disease
Blue dots on cervix
Endometriosis (answers say Nabothian Cysts)
Sudden abdo pain, well child, something indentable on the L lower quadrant
Answer says Wilm’s Tumour
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
Encourage to go to school and come back when tummy starts to hurt
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?
Could be Roseola (fever first, then rash)
14 year old kid who thieves, gets into fights (basically conduct disorder). What is first-line management
- Multisystemic (family) therapy
- CBT
- DBT
- Psychodynamic therapy
Multisystemic (family) therapy
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
Start anti-TB treatment (>5mm is positive if have TB contacts)
Definitive diagnostic test for precocious puberty?
- Bone age
- Gonadotropin stimulation test
- MRI scan of pituitary fossa
Gonadotropin stimulation test (apparently…)
Kid with hemiplegic weakness and brisk reflexes, what area of the brain is affected?
- Basal ganglia
- Pyramidal tracts
- Motor cortex
- Cerebellum
- Internal capsule
Motor cortex
Kid with rough rash on face & trunk, flushed face. No rash around mouth
Scarlet Fever (sandpaper rash)
HIV with undetectable viral load. What is contraindicated in labour?
- Forceps
- Ventouse
- Foetal blood sampling
- C-section
Foetal blood sampling
Woman with rupture of membranes and painless bleeding
Vasa praevia
17yr old girl wanting Emergency contraception more than 5 days after unprotected sex
Copper IUD
Contraception used soon after giving birth
POP immediately (IUS after 4 weeks)
Baby’s head comes out but then goes back in
Shoulder dystocia
Woman had some intrauterine growth and endometrial thickness
Fibroids
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
Continue sertraline
Post partum haemorrhage with high BP
- Carboprost
- Misoprostol
- Ergometrine
- Syntocinon
Syntocinon (ergometrine contraindicated in HTN)
Foetus with transverse lie, recent SROM – now CTG shows foetal distress
Cord Prolapse
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
LMHW and Ted stockings
Woman with raised testosterone and LH:FSH ratio 2:1
PCOS
Woman with blocked tubes on hysterosalpingogram, what treatment should you do for fertility?
- IVF
- IUI
- ICSI
IVF
Heavy periods in a girl not sexually active. What do you give her?
- COCP
- Mefenamic acid
- Transexamic acid
Transexamic acid
Poorly controlled diabetic mother, her newborn has an abnormal asymmetric Moro reflex - what’s wrong?
Brachial plexus injury
Woman on COCP, has missed 6th and 7th day pill, had unprotected sex two days ago, her urine pregnancy is clear. What to do?
Emergency contraception (also take most recent missed pill and extra precautions in next 7 days)
Woman with endometriosis, had laparoscopic adhesiolysis - had a whole range of sx - high CRP, low Hb, constipation, bowel sounds absents - what’s happened?
Perforation
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
Give antibiotics
70yo with 2 post-menopausal bleeds, TVUS shows 6mm endometrium and 3 cm simple ovarian cyst. Next step?
- Ca125
- Diagnostic laparoscopy
- Pipelle
Ca125
MMSE cut-offs
24-30: normal
19-23: mild
10-18: moderate
0-9: severe
<21: increased dementia
Some girl with anorexia was admitted and she started eating and stuff. Then she gets muscle spasms, and abdominal pain. What electrolyte most deranged?
Calcium = muscle spasms
Someone else kicking off and de-escalation has failed, what drugs?
- Lorazepam
- Lorazepam + haloperidol
- Haloperidol
Lorazepam
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
Acute psychosis
Woman blushes in public
Social phobia
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)
Hypomania
Dude with LBD, given a drug that makes him worse
Haloperidol
People with learning disabilities coming in with carers/families and their carers/families disagreeing with the doctor’s plan – what would you do first?
ALWAYS assess capacity- everyone is assumed to have capacity until proven otherwise
Dilated pupils, urinary retention, obs normal - cause of overdose?
- TCA
- Benzos
- Opioids
- SSRI
Benzos
What do you monitor with lithium?
Lithium, TFTs, U&E
Definitive diagnostic test of precocious puberty
GnRH Stimulation test (pre-pubertal respond poorly to GnRH, precocious respond well)
