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OSCE > F+C (Part 1) > Flashcards

F+C (Part 1) Flashcards

1
Q

What is your first line prescription for mild acne? Write as would be written on a prescription.

A

Isotretinoin gel 0.05%
Apply a thin layer 1-2x daily
Supply 30g

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2
Q

What is your first line prescription for acne with inflammation? Write as would be written on a prescription.

A

Isotretinoin gel 0.05%
Apply a thin layer 1-2x daily
Supply 30g

Clindamycin gel 1%
Apply a thin layer, once daily
Supply 30g

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3
Q

After trying isotretinoin and clindamycin a patient’s acne is still not settled. What is your next prescription for acne with inflammation? Write as would be written on a prescription.

A

Benzoyl peroxide 5% gel
Apply 1-2x daily, after washing
Supply 30g

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4
Q

What is your first line prescription for chlamydia? Write as would be written on a prescription.

A

Azithromycin 500mg Tablets
Take 2 tablets immediately
Supply 2 tablets

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5
Q

What is your first line prescription for vulval Candida infection? Write as would be written on a prescription.

A

Clotrimazole pessary 500mg
Insert one into the vagina, leave overnight and remove in the morning
Supply one pessary

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6
Q

What is your first line emollient prescription for a patient with eczema? Write as would be written on a prescription.

A

Diprobase cream
Apply liberally, at least 3-4 times daily
Supply 500g

Note diprobase is 2/5 on emollient ladder, if needing stronger give Epaderm ointment

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7
Q

What is your first line bath emollient prescription for a patient with eczema? Write as would be written on a prescription.

A

Dermol 600 Bath Emollient
Add 30ml to bath, do not use undiluted
Supply 600ml

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8
Q

What is your first line steroid prescription for a patient with eczema on the face? Write as would be written on a prescription.

A

Hydrocortisone 1% cream
Apply a thin layer every 12 hours
Please supply 30g

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9
Q

What is your first line steroid prescription for a patient with eczema on the trunk? Write as would be written on a prescription.

A

Eumovate 0.05% cream
Apply to affected areas, 1-2x daily
Supply 30g

Eumovate = moderate 
Betnovate = potent 
Dermovate = very potent
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10
Q

What is your first line prescription for a patient with a UTI? Write as would be written on a prescription.

A

Nitrofurantoin 50mg tablets
Take one tablet, four times per day
Supply 28 tablets (7 days)

M: 7 days
F: 3 days
Pregnancy F: 7 days
Children: 7 days

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11
Q

Write a prescription for mophine (10mg) for a patient to help manage their pain.

A 
Morphine sulphate 10(TEN)mg tablets
Take 1 (one) tablet every 4 (four) hours as required 
Supply 56 (fifty-six) tablets
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12
Q

Name 3 causes of global developmental delay

A

Prenatal: Chromosomal disorders, alcohol or drugs in pregnancy, TORCH infection
Perinatal: Hypoxic brain injury, intraventricular haemorrhage
Postnatal: Meningitis, anoxic events, head injury

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13
Q

Name three causes of an isolated motor delay (usually presenting in the first year)

A

Cerebral palsy
Congenital myopathy
Spinal cord lesion
Visual/ balance problems

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14
Q

Name three causes of an isolated languagedelay (usually presenting in the second year)

A

Hearing loss
Anatomical deficit (cleft palate)
Environmental deprivation
Normal/ familial variant

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15
Q

Name three differentials for a child presenting with a social delay aged 3

A

Autism
Hyperactivity
ADHD

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16
Q

Give two differentials for jaundice in first 24 hours of life?

A

Haemolysis

Infection

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17
Q

Give three differentials for jaundice in D2-D14 of life?

A

Physiological
Breast milk
Infection
Haemolysis

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18
Q

Give three differentials for jaundice in after two weeks of age?

A

Breast milk
Infection
Hypothyroid
Biliary atresia (conjugated)

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19
Q

What is the order of puberty in girls (5 steps) and normal age?

A

Age 10-14

Breast enlargement > pubic hair > arm hair > growth > periods (approx 12)

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20
Q

What is the order of puberty in boys (4 steps) and normal age?

A

Age 12-16

Testicle enlargement > penis enlargement > pubic hair > growth

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21
Q

Give three DDx for early puberty

A

Normal/ familial variant
Intercranial tumour
Adrenal tumour
Ovarian/ testicular tumour

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22
Q

What age is classed as early puberty?

A

M < 9years

F <8 years

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23
Q

Name 5 questions which should be asked as part of a constipation history? (Presenting complaint only)

A 
Frequency of stools 
interval between stools
Consistency of stool
Colour
Straining or pain 
Incontinence
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24
Q

Name 3 additional questions (not presenting complaint) which should be asked in a constipation history?

A

DIET
FHx of constipation problems (50% genetic)
Stress

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25
Q

What are you 5 management steps for suspected non-accidental injury?

A

FBC/ clotting to exclude other disorders
Treat + investigate injury (analgesia, imaging etc)
Photography of injuries
Refer to safeguarding lead and social/ police as appropriate
Document fully (everything possible in patients words)

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26
Q

Name 5 LOC hx differentials?

A 
Febrile convulsion (6mths-5yrs)
Seizure
Reflex anoxic seizure (in response to trigger/ bump)
Breath holding spell
Vasovagal
Arrythmia/ HOCM collapse
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27
Q

What are the three most common causes of cyanotic heart disease?

A

Transposition of great arteries (birth)
Tetrology of fallot (1-2 months)
Tricuspid atresia

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28
Q

What are the three most common causes of acyanotic heart disease?

A

VSD - Most common of all defects
ASD
PDA

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29
Q

Name 5 counselling points for a febrile convulsion

A

CAUSE - ACKNOWLEDGE DISTRESS + Reassure
Seizure management (stay out of way, call 999 if longer than 5mins or 111 before that if previous FebCons)
Take a video
1/3 will have further seizures
No evidence to suggest risk of serious illness in later life
1 in 50 epilepsy (normally 1 in 100)
Most grow out by age 5

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30
Q

Name 5 RF’s for SIDS

A 
Prematurity 
Low birth weight
Smoking in the home
Bed sharing 
Hyperthemia (overwrapping)
Sleeping prone
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31
Q

When is the 6 in 1 vaccine done? Name three counselling points?

A

At 2,3,4 months
Not a live vaccine
SE: Redness/ swelling/ bump @ injection site
Check allergies to vaccine and no current fever

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32
Q

When is the MMR vaccine given? Name three counselling points?

A

1yr and then 3yrs 4mths
Live vaccine
SE: Rash (6-10days), face swelling/ joint pain (2-3wks)
Can’t pass contamination to others
CI: Allergy/ pregnancy/ immunocompromised
Ask for gelatin free version

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33
Q

When is the HPV vaccine given, name two counselling points

A

Age 12-18 (two doses 12mths apart)
Protects against 16,18 (70% cancers) and 6+11
SE: Soreness, swelling, redness on arm (settle in 3 days)

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34
Q

Name 6 symptoms of ADHD

A

Inattention - forgetful, careless mistakes, struggle with tasks
Hyperactivity - excessive movement, fidgeting
Impulsiveness

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35
Q

Name 3 risk factors for ADHD

A

Smoking/ alcohol/ drugs in pregnancy
FHx
Low birthweight
Premature

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36
Q

Name 3 management steps when counselling for ADHD

A

1) Parent behaviour training and pyschotherapy for child and parents
2) Plan day, clear boundaries, intervene early
3) Speak to SENCO at school for support
4) Methylphenidate (OD or 2-3x/daily)

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37
Q

Name 4 complications of down’s syndrome

A 
Hearing problems (70%)
Visual problems (60%)
Heart problems (50%)
Bowel/ thyroid issues
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38
Q

When is the combined test offered, what does it consist of?

A

Combined = 10-13 weeks
Nuchal translucency
+ PAPP-A (low in DS)
HCG (high in DS)

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39
Q

When is the quadruple test offered and what does it consist of?

A

Quad = 15-20 weeks

BHCG (high)/ AFP (low)/ Inhibin-A (high)/ oestriol (low)

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40
Q

At what different times can CVS and amniocentesis be offered?

A 
CVS = 11-13wks
Amnio = >15wks
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41
Q

What are the misscarriage rates for CVS and amniocentesis?

A

CVS- 4%

Amnio- 1%

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42
Q

Name 5 differentials for a SOB child?

A 
Croup (6mths- 6yrs, seal cough, preceeding illness)
Bronchiolitis (<1yr - cough, wheeze, fluctuating, prodromal illness)
Viral induced wheeze 
Asthma
Whooping cough
Anaphylaxis 
GORD (babies)
Congenital heart disease (babies)
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43
Q

Name 5 differentials for FTT?

A 
1) Inadequate intake 
GORD
Cows milk protein allergy
Coeliac 
CF
Neglect
Pyloric stenosis/ IBD etc.
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44
Q

Name 5 lines of questioning for a FTT hx?

A

Pregnancy - Growth, smoking/ alcohol. illness
Post birth- Meconium, previous growth, NICU
Input- Breast/ bottle, frequency, hunger, feeding trouble?
Output - Energy, anorexia, nappies/ stools/ diarrhoea
Other - General health/ happiness

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45
Q

What questions should be asked before performing a newborn baby check (3)

A

Complications in labour/ pregnancy
Feeding/ latching on ok?
Passed urine and meconium?

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46
Q

What are the features of bacterial vs. viral meningitis on an LP? (2)

A

Bac: Raised neuts, raised opening pressure
Viral: Raised lymphs, normal opening pressure

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47
Q

Name two features of a fungal/ TB infection on an LP?

A

Raised lymphocytes and very raised opening pressure

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48
Q

Name 4 management points to counsel a new T1DM?

A

1) Education about spotting hypos (dizzy/ drowsy/ hungry/ sweaty)
2) Diabetic MDT care team
3) Insulin (injections vs pump, rapid vs. long acting)
4) Monitoring of glucose levels
5) Complications (eyes, kidney, nerves)
DIRECT TO DIABETES UK

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49
Q

Name 3 differentials for a poorly behaving child

A 
ADHD
Conduct disorder (fights alot)
Oppositional defiant disorder (loser temper, argues with adults)
OCD
Autism 
Attachment disorder
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50
Q

Name 3 features of autism?

A 
Delayed speech
Impaired social interaction 
Lack of awareness or interest in others
Impaired emotional ability 
Repetative or compulsive behaviour
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51
Q

Name 5 features of psoriasis?

A

Well demarcated, circular to oval
Bright red/ pink plaques
White or silvery scale
Distributed symmetrically over extensor surfaces and scalp

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52
Q

Name 3 features of eczema for a presentation?

A 
Poorly demarkated
Erythematous 
Dry
Lesions
Look eczematous 
\+/- lichenification (thickening of epidermis)
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53
Q

Name three causes of a microcytic anemia?

A

IDA
Thalassemia
Sideroblastic anaemia

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54
Q

Name thee causes of a normocytic anemia?

A

Anaemia of chronic disease
CKD
Haemolytic
Aplastic anaemia

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55
Q

Name 3 causes of a macrocytic anaemia?

A

B12/ folate deficiency (megaloblastic)
Pregnancy
Alcohol/ liver disease
Hypothyroidism

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56
Q

What treatment is given for IDA?

A

3 months of ferrous sulphate

200mg BD/TDS with review

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57
Q

What treatment is given for B12/ folate deficiency?

A

B12 injections (first) followed by folate supplementation

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58
Q

Name 5 symptoms of leukaemia?

A 
Fatigue
Dizziness
Palpations
Bone pain
Brusing
Fever
Dysponea
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59
Q

What do each of the following indicate:

1) HepA IgM
2) HepA IgG

A

1- Current infection (IgM)
2- Past infection/ vaccination (igG)

G=Gone (infection)

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60
Q

What do each of the following indicate:

1) HBsAg
2) HBeAg
3) Anti-HBs
4) Anti-HBc

A

1) HBsAg = Acute disease
2) HBeAg = Marker of current infectivity
3) Anti-HBs = Immunity (vaccine or infection)
4) Anti-HBc = Previous/ current infection (IgM <6mths, IgG >6mths)

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61
Q

What do each of the following indicate?

1) Anti-HCV
2) HCV RNA

A

1) Anti-HCV = Current/ recovered infection
2) HCV RNA = Active infection

Only treat those with +ve HCV RNA

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62
Q

How do you manage HepA?

A

Rest, fluids, antiemetics
Stop alcohol and ?paracetamol
Recovery in 3-6mths

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63
Q

How do you manage HepB?

A

No intercourse til non-infective
Treat as HepA
If HBeAg +ve then add: Peginterferon-alfa-2a (48wks)
Symptoms should resolve in 4-8 weeks

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64
Q

What % of HepB and HepC become chronic?

A 
B = 10%
C= 85% (treat same as HepB)
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65
Q

Name 5 counselling points for a patient with eczema?

A 
Keep skin dry, nails short
Avoid temperature extremes 
Avoid wearing wool or synthetics 
Recognise flare ups and infection 
90% grow out by adulthood 
REFER TO NHS WEBSITE FOR SUPPORT
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66
Q

Name 5 RFs/ triggers for Psoriasis?

A 
Genetic 
Stress
Drugs
Low sunlight
Smoking and alcohol
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67
Q

Name two tools which can be used to assess severity of Psoriasis infection?

A

PASI - Psoriasis area severity index

DLQI - Derm life quality index

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68
Q

Name 3 management options for psoriasis

A

1) Emollients
2) Vit D analogues (Dovobet also contains steroid)
3) Phototherapy/ cyclophosphamide/ methotrexate

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69
Q

You have a patient newly diagnosed with psoriasis, in addition to an emollient what should you prescribe? Write as if on an FP10 form.

A

Dovobet 0.05% ointment
Apply a thin layer once daily
Supply 30g

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70
Q

Name 5 things which should be asked about in an incontinence hx?

A 
Primary or secondary 
Triggers (cough, laugh)
Urgency
Frequency 
Dysuria 
Flow/ stream strength

PMHx (Pregnancy, childbirth)
Effects on lifestyle

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71
Q

What is first line management for stress incontinence?

A

Pelvic floor exercises
8 contractions TDS
Minimum of 3 months

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72
Q

What is first line management for urge incontinence?

A

Bladder retraining
Gradually increases intervals for minimum of 6 weeks

2) Oxybutanin

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73
Q

Name 4 differentials for incontinence

A

OAB/ urge
Stress
Mixed
Overflow from obstruction

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74
Q

Name 5 differentials for a breast lump

A 
Breast cancer (ductal most common)
Fibroadenoma 
Breast cyst
Ductal papilloma 
Inflammatory breast cancer/ pagets disease (if other syx)
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75
Q

How does scarlet fever usually present?

A

Age 2-6 (4yrs most common)
Fever: typically lasts 24 to 48 hours
Malaise
Tonsillitis
‘Strawberry’ tongue - may just have white coat
Rash - fine punctate erythema (‘pinhead’) which generally appears first on the torso and spares the face. Sandpaper like appearance

Scarlet fever - S’s (Sore throat, Strawberry tongue, Sandpaper rash, up to Six years + fever)

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76
Q

What identifiers should be checked on all 2ww referrals?

A

Name
DOB
Address
Phone number

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77
Q

What is the general Hx station structure? (7)

A 
1- Open Q's
2- PC/ HPC
3- ICE
4- Differentials out and in/ screen for red flags 
5- PMHx/DHx/FHx
6- Shx and support @ home 
7- Summarise
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78
Q

What is the most common cause of spotting?

A

Anything with progesterone

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79
Q

What four questions should be asked in all paeds histories?

A 
PIDS
P- Pregnancy/ birth
I- Immunisations
D- Development 
S- Social services
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80
Q

What phase should you use to start any explanation station?

A

Intro
“It’s the first time I’ve met you so can you bring me up to date with whats been happening so far?”
(Into brief Hx)

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81
Q

What age does coeliac disease tend to present? Name one common association?

A

8-24mnths (can be later if mild)

Associated with T1DM

82
Q

How should coeliac disease be diagnosed?

A

Trial gluten free diet

No longer do jejunal biopsy

83
Q

Name 3 red flags in a paediatric breathlessness Hx?

A

Apnoeic spells
Cyanosis
Exhaustion
Worsening symptoms

84
Q

Name 3 signs of increased work of breathing to be commented on in a paeds respiratory exam?

A

Increased RR or tachycardia
Nasal flaring
Grunting
Retractions (under neck/ breastbone)

85
Q

Name 4 things which should be asked for every paeds social history?

A

Who else is at home?
How is everyone else at home?
Does anyone smoke at home?
Nursery/ school?

86
Q

A child presents with croup like symptoms, what is your main differential to rule out and what should you not do?

What is the causative pathogen?

A

Acute epiglottitis
- More sudden onset than croup and more severe, higher fever, will be very unwell, caused by HiB (normally vaccinated against)

DO NOT - examine throat
DO - admit urgently to hospital

87
Q

How will an autosomal dominant condition show on a family tree?

A

Someone in every generation affected

88
Q

How will an autosomal recessive condition show on a family tree?

A

Unaffected parents > affected child

89
Q

How does an x-linked condition show on a family tree?

A

M to M transmission (almost exclusively)

90
Q

What is the most common cause of bacterial meningitis if 0-3mths?

A

Group B Strep

91
Q

What is the most common cause of bacterial meningitis if >3mths?

A

Streptococcus pneumoniae

(2nd) Neisseria meningitides

92
Q

What is Duchenne’s muscular dystrophy? Name 3 counselling points for an explanation station?

A

X-linked recessive disorder (so almost only males affected)
Problem with dystrophin genes = muscle necrosis
Normally clumsy as kids, wheelchair by teens, dead by 20’s
Associated with Gowers sign (too weak to get up from sitting), Pseudohypertrophy of calves
1/3 have learning difficulties

93
Q

What diagnosis/ management is offered for Duchenne’s muscular dystrophy?

A

Dx: Raised CK > muscle biopsy > DNA test
Physio
Supportive
Genetic counselling
NIV overnight (poor function of resp muscles)

94
Q

What structure should be used for a diabetic pre-pregnancy counselling station?

A

Intro/ how can I help?
I’m not familiar with your case… brief HX
Why now/ other pregnancies/ are you already trying
Explain risks (worsen mums diabetes, baby = macrosomia, miscarriage, heart defects)
ICE
Make plan, offer short term contraception, start on folic acid

95
Q

When doing diabetic counselling for pre-pregnancy what drug advice should be given?

A

Metformin (plus insulin if needs better control)
NO- Gliclazide, ACEI, statins
Start folic acid!

96
Q

What is the bishops score, what sort of cut offs are used?

A

To predict whether labour will begin spontaneously
<5 = very unlikely to start
>7 = labour should commence easily

97
Q

Name two CI to the POP?

A

Breast ca, undiagnosed PV bleed

98
Q

How should patients be advised regarding taking the POP?

A

Take at same time every day
If miss dose, take as soon as remembered, if you miss just one day thats ok, miss 2 or more then you need to use additional protection

99
Q

When are the POP and COCP effective from?

A

D1-D5 in cycle = immediate
Any other time
- POP = within 48hrs
- COCP = within one week

100
Q

How should patients be followed up for the COCP and the POP?

A

Review in 3 months, then every 12 months

BP, heigh and weight, smoking check

101
Q

Name the structure of every contraception station? (6)

A

Intro- how can I help?
What contraception do they know? Considered any others? Why that one?
Short or long term/ good with tablets?
Is there anything specific you’d like to know about X?
CATHLETICS
ICE
Note doesn’t protect against STI’s!!!

102
Q

Name 3 CI to having a coil inserted?

A

Current pelvic infection
PID < 3mths
Undiagnosed PV bleed
High STI risk (multiple partners)

103
Q

What are the risks associated with coil insertion?

A

Expulsion (1 in 20 so coil check at 6 weeks)
Perforation (1 in 10000)
Bleeding
Infection

104
Q

What history should be taken in an emergency contraception station?

A

Exact timing
Using any contraception at the time?
Was it consensual?
ICE

105
Q

What 5 things should be counselled on in any emergency contraception station?

A

Choice of medicine and how to take (timeline)
Side effects - nausea, tiredness, headache
Was the sexual
STD risks
Signs of ectopic (abdo pain, vag bleed)
Offer long term contraception

106
Q

What options are available for emergency contraception?

A

1) Copper coil (within 5 days)
2 - Levonelle (within 72hrs, start other contraception within 2 days)
3- EllaOne (within 120hrs, best options, start other contraception within 5 days)

107
Q

Name 5 contraindications which must be checked before starting the COCP?

A

How are your periods?

I’ll need to check a few things like your BMI (>35) and blood pressure
Smoker > 35
Migraine with aura
Hx of clots in legs or lungs (or strong FHx)
Post-natal <6weeks
Hx Breast or liver cancer

Check they are not pregnant!

108
Q

What advice should women be given regarding taking the COCP?

A

Take at same time every day
Take for 21 days then 7 day break (can get dummy pill packs)
If miss dose, take as soon as remembered, if you miss just one day thats ok, miss 2 or more then you need to use additional protection for one week

109
Q

Name 4 hormonal side effects of the pills, which pill tends to have worst SE’s?

A

Weight gain, acne, mood changes, headache < long term

Breast tenderness and intermittent bleeding < tends to resolve in 3 months

COCP tends to be worse

110
Q

COCP increases your risk of (A) and decreases risk of (B)

A

A- Breast and VTE/ HTN

B - Endometrial and ovarian

111
Q

How should an ectopic pregnancy be explained to a patient?

A

Intro- How can I help?
SPIKES
(What, why, consequences, management)
- Don’t forget to say risk of death!

112
Q

What are the three management options for ectopic?

A

Low risk - Expectant (HcG <200, mass <3cm)

Med risk- Single dose IM methotrexate
- Do HCG on D4 and D7 (15% decrease)

High risk- Salpingectomy

113
Q

What 4 factors should a patient about to undergo a salpingectomy be counselled on?

A 
GA and laproscopic 
ICE - find out specific concerns 
No decreased risk of fertility 
Can try again straight away 
10% risk of future ectopic so needs USS @7wks

If no other tube/ other fertility reasons can consider salpingectomy

114
Q

Name 5 symptoms of menopause?

A 
Hot flushes
Night sweats
Vaginal dryness
Poor sleep
Low mood/ anxiety
Low sex drive 
No periods (for 12 months)
115
Q

What are the different types of HRT and when should each be prescribed?

A

Cyclical - If LMP <1yr ago
Continuous - If LMP >1yr ago, or 2yrs if premature failure
Oestrogen only - Given only to those who don’t have a uterus!

116
Q

What modes can HRT be delivered by? (3)

A

Patch, tablet, cream, pessaries etc.

117
Q

Name 6 contraceptive options?

A 
Mirena coil
Copper coil
COCP
POP
Implant - lasts 3 years 
Weekly patch 
Depot injection - 3 monthly 
Condoms
118
Q

What are the three most common post-partum mental health conditions, when do they each occur?

A 
Baby blues (60%) : D3-D7 - Support + reassure
Post-natal depression (10%) : 1-3mths - S+R, CBT, sertraline if severe (safe for breastfeed)
Puerperal pyschosis (0.1%) : 2-3wks : Admit to hospital, 20% chance of reoccurance
119
Q

What are your top 5 differentials for menorrhagia?

A 
Dysfunctional uterine bleed (60%)
Fibroids - look for urine/ constipation symptoms 
Cervical or endometrial polyps
Bleeding disorders i.e. Von Willibrands 
Thyroid disease
120
Q

What 5 questions should be asked about all bleeding from the vagina in PC/HPC?

A 
Timing 
- Onset (acute of gradual + when)
- Duration (intermittent or continuous)
- Progression
Bleed
- Amount
- Clots
- Pain
- Urinary or bowel symptoms
121
Q

What are the first three lines of treatment for fibroids?

A

1) COCP/ transexamic/ mefanamic
> If no success then TVUS
2) GnRH agonist (leuprolein)
3) Myomectomy

122
Q

Which 7 areas should be covered in an infertility hx?

A

How long trying? Reassure 80% in one year, 90% in 2 years
Takes two to make a baby so need to ask about you and your partner - do either have children already?
Intercourse (How often/ methods/ contraception)
Gynae Hx (MOSC)
Medical Hx (Bleeding, pain, dysparenunia - PCOS and endometriosis symptoms)
Weight/ smoking/ alcohol

123
Q

What does the acronym PISS WARD F stand for?

A 
P- pre existing medical conditions
I- Intercourse (frequency, method)
S- Smoking
S- Smears 
W - Weight
A - Alcohol
R - Rubella
D - Drugs
F - Folic Acid (400mcg)
124
Q

Name 5 differentials for infertility?

A 
Unknown cause (25%)
Ovarian - an-ovulation i.e. PCOS, prem ovarian failure
Tubal/ uterine disoders - PID/ endometriosis
Male factor
125
Q

Name 5 risk factors for miscarriage?

A 
20% of all pregnancies!
Previous miscarriage 
Alcohol
Drugs
Smoking
Diabetes
Increase age
126
Q

What investigations should be done for all miscarriages?

A

TVUS + hcG (confirm if complete or incomplete)

- Rule out ectopic

127
Q

What are the management options of an incomplete miscarriage? (4)

A

Bereavement counselling!!!

1) Expectant - preg test in 3 weeks
2) Medical - mifepristone + mifeprostol 48hrs later as pessary
3) Surgical - under LA, tube hoover into cervix

128
Q

What acronym is used to remember gynae histories?

A 
MOSC
M- Menstrual (LMP plus details) 
O- Obstetric
S - Sexual 
C - Contraception + cervical smear
129
Q

What acronym is used to remember obs histories?

A 
WIMPP
W- Weeks, first baby?
I - Issues (Apppointments, scans, health)
M - Movements (refer at 24 wks)
P - Previous pregnancies (+outcomes)
P - PMHx/DHx/SHx
130
Q

What acronym is used to remember sexual histories?

A 
SEX CASP
S- Sexually active?
Ex- Partners (number and M/F)
C - Condoms and contraception
A - Activites (Vag, oral, anal)
S - STI's 
P - Paid for/ same sex/ abroad (high risks)
131
Q

Name 5 risk factors for prematurity?

A

Before:
Multiple pregnancy/ Overweight/ Diabetes/ Fertility Tx
During:
Infection/ Pre-eclampsia / Polyhydramnious /Placenta praevia

132
Q

What is the structure of all obstetric stations which require an explanation? (4)

A

Intro + how can I help?
I’m not familiar with your case… how’s pregnancy been so far… Brief Obs Hx (WIMPP) including PMHx etc.
SPIKES for topic explanation
Summary, their choice, give leaflet

133
Q

What risks regarding prematurity should parents be counselled on?

A

May need to go to NICU
Need help with breathing/ feeding/ staying warm
Born after 28weeks (80% survive)
Increased risk future birth of prem

134
Q

How should you counsel a woman regarding breast screening (structure)?

A

How can I help?
Any specific concerns?
Explain pro’s and con’s
Explain process

135
Q

Name 4 risk factors for developing candidasis?

A

Diabetes
Pregnancy
DHx - Antibiotics/ steroids
Immunosuppresion

136
Q

What are your top 5 differentials for a post-coital bleed?

A 
Infection
Cervical ectropion (Increased risk with COCP)
Atrophic 
Cervical/ endometrial polyp
Cervical cancer
Trauma
137
Q

What are your top 5 differentials for intermenstrual bleeds?

A 
Idiopathic (50%)
Hormonal (increased risk if on pill)
Polyps 
PID (pain/ dysparenunia)
Fibroids
138
Q

What management steps do you undertake for a vaginal bleed - including referal? (5)

A

Refer (over 45, mass, abnormal cervix, high cancer risk)

Examination
Pregnancy test, swabs for STI’s
FBC and TFTs, clotting
TVUS

139
Q

What acronym is used to interpret a CTG?

A

DR C BRAVADO
Dr- Define risk (Diabetes, HTN, multip, previous etc.)
C- Contractions (in 10 mins)
Bra- Baseline rate (110-160)
V - Variability (Normal 5-25)
A- Accelerations (normal)
D- Decelerations (variable are normal if <90mins)
O - Overall (reassuring, non-reassuring or abnormal)

140
Q

Name three causes of a fetal tachycardia on a CTG?

A

Fetal hypoxia
Chorioamnionitis
Fetal or maternal anaemia

141
Q

Name three causes of a fetal bradycardia on a CTG?

A

Cord compression
Cord prolapse
Epidural

142
Q

Name the most common cause of late deceleration’s on a CTG?

A

Fetal hypoxia and acidosis

Can be from Pre-eclampsia or maternal hypotension

143
Q

How do you investigate late deceleration s on an CTG?

A

Do FBS

If acidosis then do c-section

144
Q

What are the key steps in a vasectomy explanation station? (7)

A

Intro - how can I help?
History- Why now, previous children, brief PMHx
Options- how much do you know? Others considered?
Concerns
Explain procedure
Empathy, give time to make decision
S: Leaflet

145
Q

A patient asks you to explain a vasectomy to him, name 5 points you’d counsel on?

A

Done under LA as a day case
Will still ejaculate as normal
Test 12 wees post-procedure to check effectiveness
1 in 2000 failure rate (very small)
Very small risks of bleeding and infection with procedure

Make sure they’ve thought it through and won’t regret it! Reversal is not always available on the NHS and success rates aren’t great

146
Q

Name 5 parts of a primary ammenorrhoea Hx?

A 
(No menses by 14)
Other secondary sexual characteristics 
Family menses timing 
HPC: Pain (cyclical), discharge 
PMHx, DHx (contraception)
SHx (Eating, stress, exercise)
147
Q

A 16 year old girl presents with primary ammenorrhoea, what’s the most likely cause and how should she be counselled?

A

Likely constitutional delay
- Periods are last thing to develop
If all other secondary sexual characteristics are normal then reassure.

148
Q

What are your top three differentials for primary ammenorrhoea?

A

Consitutional delay
Imperforate hymen
Hyperprolactinemia (hypothyroid/ pituitary tumour)

149
Q

What investigations (4) would you do for primary ammenorrhoea?

A

HcG (rule out pregnancy)
FSH/ LH < pituitary tumour causing hyperprolactinaemia
TFT < hypothyroid
Prolactin

150
Q

What are your top 5 differentials for a secondary ammenorrhoea?

A

Pregnancy, lactation < Always rule this out!
Menopause or premature ovarian failure
PCOS (acne, alopecia, obesity) < very high LH
Post-contraception
Thyroid disease < weight gain, lethargic, constipation
Weight loss/ cushings < Low BMI

151
Q

What investigations (4) would you do for secondary ammenorrhoea?

A

1) HcG < rule out pregnancy
2) FSH+LH < Raised if POM, low if hypothalamic cause
3) Prolactin < raised if pituitary tumour
4) TFT < hypothyroid

152
Q

Name 4 lines of management options for endometriosis?

A

1) Do nothing (30% get better, 40% get worse)
2) Paracetamol, NSAIDS, codiene
3) COCP or mirena coil
4) INVESTIGATE < DIAGNOSTIC LAPROSCOPY (see and treat approach)

5) Hysterectomy

153
Q

What are the complications of a see and treat laproscopy for endometriosis? (4)

A

General anaesthetic
Adhesions in pelvis (stuck together can cause problems)
Infection
50% reoccurance in 5 years

154
Q

Name 5 symptoms of endometriosis?

A 
Cyclical pain and other pain 
Dysparenuina 
Heavy periods 
Pain after going to the the toilet 
Sickness, constipation, diarrhoea 
Problems getting pregnant
155
Q

Name two protective/ relieving factors for endometriosis?

A

Multiparity

COCP

156
Q

What are the Rotterdam criteria?

A

Diagnosis of PCOS needs 2/3

1- Oligomenorrhoea (<9/yr)
2- Polycystic ovaries (>12 follicles or >10cm3)
3- Clinical/ biochemical hyperandrogenism (alopecia, acne, hirsutism)

157
Q

What are your firstline investigations if suspecting PCOS?

A

Pelvic US (for cysts)
Gonadotrophins (FSH/ LH) < normal in PCOS, however very very high can indicate PremOvarianFailure
TFT (exclude thyroid cause)
Glucose tolerance test (assess insulin resistance)

158
Q

How should PCOS be managed? (6)

A

Advise on complications (weight, CHD, infertility, cancer, T2DM) - can’t be cured but tx symptoms

1) COCP or IUS (reduce risk endometrial cancer)
2) Orlistat (help weight loss)
3) Metformin (if insulin resistance problems)
4) Co-cyprindol (for hirsuitism or acne)
5) Clomifene (for fertility)

159
Q

Name 5 complications of PCOS?

A 
Weight gain (dyslipidaemia)
T2DM (insulin resistance)
Endometrial cancer (lack of bleeds)
CVD (due to weight, sugars etc.)
Infertility
160
Q

What are the four most common causes of PPH (in order)?

A

Tone - uterine atony
Tissue - retained placenta
Trauma - eg. from operative delivery
Thrombin - Coagulopathies

161
Q

Namw 5 risk factors for PPH?

A 
Previous PPH
Placenta praevia (12x)
Retained placenta (4x)
Episiotomy/ operative delivery 
Multiple pregnancy
Induction of Labour
Big baby/ obese mother 
Fibroids
162
Q

Name 4 complications of PPH

A 
Hypovolemic shock
AKI
DIC
Sepsis
Death
163
Q

What are your 7 management steps of a PPH

A

1) ABCDE + emergency button to get team in
2) Uterine rub
3) Bimanual compression
4) Oxytocin/ ergometrine
5) Misoprostol or carboprost
6) Ballon tamponade/ suturing in theatre
7) Bilateral uterine artery ligation/ hysterectomy

164
Q

What questions should be asked about in a PMB hx?

A

O- When did it start?
C - Heavy/ light
R
A - Pain, dryness, dysparenunia, Postcoital bleed,
T- Has it happened before? Getting better or worse?
MOSC - RF’s (early menarche, nulliparious, late menopause)
- RF’s not in MOSC (PCOS etc.)

165
Q

What are your top 5 differentials for a PMB?

A 
Atrophic vaginitis 
HRT use
Endometrial hyperplasia 
Endometrical ca
Cervical cancer
Cervical/ endometrial polyp

50% are idiopathic!

166
Q

What percentage of women will experience a PMB, what percentage of these are cancer?

A

Up-to 10% all women experience PMB
Of these 1 in 10 will be endometrial cancer

(This should be explained when doing the 2ww)

167
Q

What is the first line treatment for endometrial cancer?

A

Hysterectomy with bilateral salpingoophrectomy
+/- radio/chemo is stage II/III/IV

(if fertility needed then do surgical excision and progesterone tx)

168
Q

Name 5 risk factors for endometrial cancer

A 
Increasing age
Early menarche
Late menopause
Nulliparity 
Late age of first child
Bottle feeding
Diabetes
PCOS
Tamoxifen use
169
Q

How should a woman be counselled for Hysterectomy with bilateral salpingoophrectomy?

A

Removal of womb, ovaries, fallopian tubes and cervix
Need GA
5 days in hospital, 6-8 weeks recovery time
Risk: Bleeding, infection, damage to bladder or bowel
WILL go through menopause if hasn’t already

170
Q

What symptoms are common with fibroids?

A

Heavy periods
Abdo pain
Increased wind and constipation
Pain during sex

171
Q

What are you first three management steps for fibroids?

A

1) Nothing - will improve during menopause so can leave
2) COCP, transexamic or mefanamic acid
3) Leuprorelin or mifepristone
4) Myomectomy or hysterectomy

172
Q

Name 3 complications of fibroids in pregnancy?

A

IUGR
PPH
Prematurity

173
Q

What are fibroids, what age do the affect and what do they normally grow in response to?

A

Non-cancerous growths of muscle/ fiberous tissue
Affect 15-50 (Rf’s all oestrogen exposure)
Grow in response to oestrogen

174
Q

What are polyps and what symptoms do they cause?

A

Overgrowth of the womb, most not cancerous but can become precancerous then cancerous

Syx: Heavy bleeding, irregular bleeding, IMB, PMB

175
Q

How are polyps investigated and treated?

A

I: Hysteroscopy
Tx: Hysteroscopy under LA or GA

176
Q

What are the 5 steps to conducting a home birth counselling station?

A

Intro

1) Why do they want this and ICE
2) Take brief medical Hx (determine risk)
3) Explain it’s their choice, however you are there to advise
4) Discuss pro’s and con’s
5) Offer options (middle ground = midwife led unit)

177
Q

What are the pros (1) and cons (3) of a home birth?

A

Pro- More relaxing for mother
Con-
1) Can’t access drugs/ equipment if something goes wrong
2) Can’t have epidural if wants one
3) Can’t always get a doctor to you in time if needing help

(Birth centre compromise)

178
Q

What are the 5 steps to conducting a breech counselling station?

A

Intro

1) What do they know so far (P)
2) ICE - what do they want to know
3) Explain breech and draw picture
4) Explain risks
5) Explain options (ECV-50% work so C-section is backup)
6) Ask mum what she’d like to do

179
Q

What is the management of a breech presentation for which ECV is failed at 38 weeks?

A

Deliver by c-section at 39 weeks

180
Q

Name three counselling points for an ECV

A

Takes 15mins, some drugs to soften uterus
Very safe, rare complication PROM, abruption or badycardia - baby monitored all the way through
Stay for an hour or so to be monitored, return in one week to double check
50% success rate

181
Q

Name 2 risks of a breech delivery?

A

Cord prolapse
= Oxygen not delivered

= cerebral palsy, death

Risks of damaging mum (trauma)

182
Q

What order should a breast vs. bottle counselling station be done in?

A

1) Intro
2) Thoughts on preference? Heard from other mums? Why?
3) It’s always your choice but I can talk you through pro’s and cons
4) Any specific questions?
5) Pros vs. cons
6) Their decision

183
Q

Name 3 pro’s for bottle feeding over breast?

A

More convenient - anyone can feed
Need feeding less often
Medically might not be able to produce enough

184
Q

Name 5 pro’s for breast feeding over bottle

A

WHO and NHS advised (exclusive to 6mths, ween at 1yr)
All nutrients needed - less likely to have diarrhoea
Cheaper
Better for babies immune system
Can prevent asthma, allergies and obesity
Helps mum and baby bond
Helps mum lose weight
Reduces mums chance of some cancers

185
Q

How should pre-eclampsia be managed?

A

Admit all women with pre-eclampsia

1) Start labetalol
2) If severe risk start magnesium sulfate
3) Three times weekly bloods (looking for HELLP) and 4x daily BP’s

Only definitive Tx is delivery, do any time after 37 weeks (give steroids if doing early or to mums likely to delivery early)

186
Q

Name 5 risk factors for pre-eclampsia. What action should be taken if risk factors are present?

A 
Previous pre-eclampsia
Family hx
Diabetes
Kidney disease
Obesity 
Over 40
Lupus

If >2 RF’s then give Aspirin from 12weeks

187
Q

How many pregnancies are affected by pre-eclampsia?

A

1 in 20

1 in 100 severely

188
Q

Name 4 complications of pre-eclampsia?

A

Eclampsia (seizures > give magnesium sulphate)
HELLP (haemolysis, elevated liver, low platelets)
Increased risk of stroke, liver and renal disease
Inreased risk of pre-term labour and stillbirth

189
Q

What is hyperemesis gravidarum?

A

70% of women experience morning sickeness. For 1% this is very severe and called HG

190
Q

Name 3 symptoms of hyperemesis gravidarum?

A 
N+V (some upto 50x/day)
Low BP (postural hypotension especially)
Dehydration
Ketosis
Weight loss
191
Q

How do you manage HELLP syndrome?

A

1) IV labetolol
2) Magnesium sulphate
3) IV dexamethosone

192
Q

When do morning sickness and HG typically resolve by?

A

Morning sickness resolves by 14weeks

HG by 20 weeks although can continue to term

193
Q

Name some complications for mum and baby of hyperemesis gravidarum

A 
Doesn't harm baby!
Maternal weight loss may lead to small baby
Maternal depression
Maternal exhaustion 
Likely to reoccur in future pregnancies
194
Q

How is hyperemesis gravidarum treated? (6)

A

R- Refer if severe dehydration or ketosis
C - Advice on diet
M- Cyclizine or promethasine for sickness
+ Thiamine, LMWH and fluid/ nutrition support

2nd line - add steroids

195
Q

What is TV and what is your first line treatment for?

A 
Trichomonas vaginalis (parasite)
Causes smelly, yellow/green, frothy discharge 
Tx: Metronidazole
196
Q

What is BV and what is the first line treatment?

A 
Bacterial vaginosis (not STI)
Fishy, thin white discharge 
Tx: 7 days of oral metronidazole
197
Q

What sort of bacteria is gonorrhoea? What is the incubation period and the first line tx?

A

Gram negative diplococci
2-5 days incubation period
Ceftriazone 500mg IM and azithromycin stat (also helps cover co-existing chlamydia)

198
Q

How is herpes treated?

A

Oral acyclovir

199
Q

What structure should be used for a vaginal discharge hx?

A

COCP-DBT
(Colour, odour, consistency, pain, duration, blood, timing)

Plus MOSC (menstrual, obs, sexual, contraception)

200
Q

What are the steps to reporting a chest x-ray?

A

Patient details (Name, date)
Quality (Projection, exposure, inspiration, rotation)
Obvious abnormality
ABCDE

Ask for previous image to compare

OSCE (6 decks)

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