GetAhead Specialities EMQs

Question 1

What elevation of only alpha-fetoprotein alone may mean?

Answer 1

Break in a fetal skin → neural tube defect (e.g. spina bifida) or anencephaly

*further testing/imaging is needed to confirm spina bifida

Question 2

What age of gestation do we perform:

a) amniocentesis
b) chorionic villus sampling

Answer 2

a) amniocentesis →15 weeks and above
b) chorionic villus sampling → 11- 14 weeks

*both tests are diagnostic - they will give definitive answer if a condition is present

Question 3

What’s a ‘low risk ‘ovarian cyst and what to do?

Answer 3

• USS: unilateral, simple, <5 cm
• normal Ca 125

Conservative management, if an asymptomatic patient

Repeat scan in 3-4 months (as 50% ill resolve)

*high risk cysts -> opposite to above -> manage by surgical excision

Question 4

Patient >60 y old and new iron-deficiency anaemia. What to do?

Answer 4

Urgent colorectal cancer pathway referral

Question 5

Examples of live attenuated vaccines (7)

Answer 5

• BCG
• MMR
• oral polio
• yellow fever
• oral typhoid
• oral rotavirus
• intranasal influenza

These to be avoided if a patient is on immunosuppressive treatment / immunocompromised

Question 6

What are adverse features of patients with tachycardia?

Answer 6

Following ABC assessment, patients are classified as stable/unstable according to the presence of aby adverse signs:

• syncope
• shock: BP <90, pallor, sweating, confused/impaired consciousness, cold. clammy extremities
• heart failure
• myocardial ischaemia

If any of the above signs are present → give DC synchronised shock (synchronised cardioversion)

Question 7

What levels of fasting glucose indicate impaired glucose regulation/pre-diabetes?

Answer 7

6.1-6.9 mmol/l

42-47 mmol/mol

Question 8

What’s Lemmiere’s syndrome?

Answer 8

Lemierre’s syndrome:

• infective thrombophlebitis of the internal jugular vein
• caused by Fusobacterium necrophorum
• it is a complication of a throat infection when it spreads through the tissues in the neck to cause an infected blood clot
• this can cause sepsis as well as embolism to the lungs

Question 9

Hypertension treatment - 4 steps

Answer 9

Question 10

What’s recommendation of Rx of DKA (dose)?

Answer 10

A fixed rate IV insulin infusion of 0.1 units/kg/hour

Question 11

What symptoms can deficiency of each vitamin ADEK cause?

Answer 11

• Vitamin A: poor night vision and general vision
• Vitamin D: poor bone and muscle strength
• Vitamin E: myopathies, neuropathies, ataxia
• Vitamin K: easy bruising

Question 12

1st line Rx for:

• generalised seizures
• focal seizures

Answer 12

Generalised: Sodium Valproate

Focal: Carbamazepine

Question 13

Treatments (1st and 2nd line) for general tonic-clonic seizures

Answer 13

1st line: sodium valproate

2nd line: lamotrigine, carbamazepine

Question 14

Drug treatment for absence seizures

Answer 14

Absence seizures* (Petit mal)

• sodium valproate or ethosuximide
• sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy

Question 15

What anti-convulsive (1) drug may exacerbate absence seizure and myoclonic seizures?

Answer 15

Carbamazepine

Question 17

When in gestation can CTG be used?

Answer 17

From 32 weeks gestation

*measures foetal HR and uterine activity

Question 18

What’s normal range of foetal HR?

Answer 18

110-160 beats/min

Question 20

The labour triad of passages

Answer 20

• power → uterine contractions
• passage → birth canal
• passenger → the foetus

Question 21

When is the pregnant uterus palpable?

Answer 21

From 12 weeks

Question 22

Anatomical location of the pregnant uterus in:

• 20 - 22 weeks
• by 36 weeks

Answer 22

• 20 - 22 weeks → reaches the umbilicus
• by 36 weeks → lies under the ribs

Question 23

What elements must be determined in obstetric palpation?

Answer 23

• number of foetuses
• lie (longitudinal, oblique or transverse)
• presentation (cephalic or breech)
• engagement
• measure symphysis-fundal height (from 16 weeks, this will increase approx 1cm/week)
• auscultate the heart (Doppler USS from 12 weeks, Pinard stethoscope from 24 weeks)

Question 24

If the SROM (spontaneous rupture of membranes) is suspected, do we do vaginal examination?

Answer 24

No, it is better to do speculum exam (to avoid the infection)

Question 25

What’s an absolute contraindication to the manual vaginal exam?

Answer 25

Placenta Previa

Question 26

What’s the most preferable position of baby’s presentation at labour?

Answer 26

Occipitoanterior

Question 27

How do face and brow presentation (labour) look like?

Answer 27

• brow is the least common presentation (1 in 2000) → it may delay 2nd stage of labour (head is required to rotate - otherwise its diameter is too large to pass through pelvis)
• face occurs 1 in 500 → it can delay engagement and progress; also it may lead to facial oedema

Question 28

Risk factors for breech presentation

Answer 28

• multiparity
• bony pelvic abnormalities
• uterine abnormalities
• fetal prematurity (insufficient time to rotate)
• multiple pregnancies
• fetal abnormality
• extended legs
• oligo/polyhydroamnios
• placenta previa

Question 29

External Cephalic Version (ECV)

• when can be performed
• contraindications to ECV

Answer 29

• performed at 37 weeks
• contraindications: previous CS, Hx of antepartum haemorrhage, multiple pregnancies, oligo/polyhydroamnios, placenta previa

Question 31

What findings (blood tests) are diagnostic for menopause?

Answer 31

low oestradiol (<70 pmol/L) despite high LH and FSH