MMF Practice Paper Flashcards
Do patients with previously identified GBS require antibiotic prophylaxis for a planned C section?
No - as long as there are no signs of labour or membrane rupture, there is no need for IV antibiotic prophylaxis for GBS for planned C-sections
What is the antibiotic of choice for GBS prophylaxis? When is it given?
IV Benzylpenicillin
previous baby with GBS / previous colonisation
and in labour / has ruptured membranes
What can be given for GBS prophylaxis in patients with penicillin allergies?
IV Cefuroxime
Give some risk factors for reduced fetal movements
distraction
obesity
anterior placental position
polyhydramnios
alcohol, benzodiazapines
SGA baby
How should RFM beyond 28 weeks be investigated?
handheld doppler
no heartbeat = immediate USS
heartbeat = CTG for 20 minutes
At what point should a woman be referred if she has not yet felt baby move?
24 weeks
refer to maternal-fetal medicine unit
Give some risk factors for retinal detachment
diabetes mellitus:
occurs as a result of breaks in the retina due to traction by the vitreous humour
myopia
age
previous surgery for cataracts (accelerates posterior vitreous detachment)
eye trauma e.g. boxing
A 67-year-old man presents to the GP for a general health check. His full blood count shows his haemoglobin levels to be 191g/L and after further investigations and no other cause to explain his polycythaemia, he is diagnosed with polycythaemia vera.
What is least likely to form a part of his condition?
High erythropoietin levels
Splenic enlargement
Erythromelalgia
Aquagenic pruritus
Conjunctival plethora
High EPO
This patient has polycythaemia and is likely to have LOW EPO due to negative feedback from his high Hb
Raj is a 68-year-old man brought in by ambulance following sudden onset difficulty walking, perianal numbness and faecal and urinary incontinence after attempting to lift a heavy crate at work.
What is the immediate treatment for the most likely diagnosis?
spinal cord decompression
High dose dexamethasone is the initial drug treatment given in MSCC to decrease inflammation, but in this case a herniated disc is causing the CES
Which of the following documents is legally binding?
Advanced Statement
ReSPECT Form
Advanced Decision to Refuse Treatment
DNACPR Form
An Advanced Decision to Refuse Treatment - signed by the patient, dated and witnessed
What is involved in calculating a patient’s Waterlow Score?
Gender
Age group
BMI
Skin type
Mobility
Continence
Recent weight loss
Appetite
Tissue malnutrition
Neurological deficit
Major surgery or trauma
Medication
Care that is provided to patients when they are at risk of being sent to hospital, is known as what?
Continuing Care
Discharge to Assess Process
Interim Care
Intermediate Care
Intermediate Care - provided to patients, usually older people, after leaving the hospital or when they are at risk of being sent to the hospital – it helps avoid going into hospital or residential care unnecessarily
What is continuing care?
fully funded package of care that some people are entitled to due to disability, accident or illness – it covers the full cost of care and residential accommodation
What is the discharge to assess process?
reduces time spent in the hospital at the point where people no longer need acute care – it allows for continuing of care and assessment out of the hospital
What is interim care?
in-home support on a temporary basis
Give some maternal complications of diabetes during pregnancy
Higher risk of hypo/hyperglycaemia
Pre-eclampsia
Pre-term labour
Need for instrumental delivery/C-section/induction of labour
Miscarriage
Progression of retinopathy/nephropathy
Give some fetal complications of gestational diabetes
Congenital abnormalities
Still birth
Macrosomia/shoulder dystocia/Erb’s palsy/fractures during birth
Hypoglycaemia
Need for intensive care in neonatal period
Long term risk of obesity/DM
Give 3 things that should be done in the management of a diabetic woman who is trying to conceive
5mg folate daily until 12 weeks pregnant to reduce the risk of neural tube defects
Do U&Es and protein:creatinine ratio because there is a high risk of deterioration of established nephropathy during pregnancy
Fundoscopy to assess for retinopathy as there is a risk of deterioration during pregnancy
Give 4 clinical features of pre-eclampsia
Blurred vision
Abdominal pain
Nausea/vomiting
Swelling of hands/face/feet
Give some contraindications to VBAC
Previous uterine rupture
2 or more previous C sections (relative contraindication)
Classical Caesarean scar
Contraindications to labour e.g. major placenta previa
What findings on USS point towards a diagnosis of PCOS?
polycystic ovaries on ultrasound scan (defined as the presence of ≥ 12 follicles in one or both ovaries and/or increased ovarian volume > 10 cm³)
Give some causes of sudden loss of vision
Retinal detachment
Amaurosis Fugax
Vitreous haemorrhage
CRAO/CRVO
What may be seen on a CXR of a patient with lung cancer?
multiple opacifications
hilar enlargement
unilateral pleural effusion
consolidation / collapse
Other than chemotherapy, give 4 medical interventions that could be done to support a child with ALL
blood transfusion for low Hb
antiemetics
antibiotics if neutropenic
nutritional support and fluids
State 4 signs or symptoms of subarachnoid haemorrhage other than thunderclap headache
LOC
Neck stiffness/ meningism
Photophobia
Nausea/vomiting
Seizures
Ptosis
Vision changes (diplopia), vision loss
Agitation/ behavioural change
Focal neurological deficits
List 3 (short or long term) complications of subarachnoid haemorrhage
Rebleed
Hydrocephalus
Increased ICP/ brain herniation
Cerebral infarct
Vasospasm
Seizures
Give 3 features that can be used to prognosticate in SAH
conscious level on admission
age
amount of blood visible on CT head
How can a confirmed SAH be managed?
best rest, analgesia, reveral of anticoagulation
nimodipine to prevent vasospasm
coiling or clipping within 24 hours
If antibiotics are indicated in acute otitis media what is given?
PO amoxicillin for 5-7 days
How should a patient with suspected melanoma be managed?
2ww referral to dermatology
Excision biopsy with 2 mm margin to confirm diagnosis
Followed by a wider excision with the margin depending on the depth of the melanoma +- sentinel lymph node biopsy
What is the most common type of malignant melanoma?
superficial spreading malignant melanoma
Which type of malignant melanoma is seen more frequently in POC?
Acral lentiginous melanoma
List some non-pharmacological interventions you could use to support a delirious patient
Verbal de-escalation techniques
Environmental modifications e.g time and place orientation, continuity of healthcare staff, well-lit room with minimal noise
Ensure bowels open regularly
Ensure sufficient nutrition / hydration
Ensure good sleep hygiene
Give some complications of poorly controlled delirium
Falls risk
Increased risk of aspiration pneumonia
Increased risk of dementia in the future
Affects patient independence and confidence
Other than diarrhoea and weight loss, suggest some presenting features of coeliac disease
Failure to thrive
Fatigue
Mouth ulcers
Dermatitis herpetiformis
Peripheral neuropathy
Cerebellar ataxia
Epilepsy
List some follow up investigations that are required for children with Down’s syndrome
Regular thyroid checks (2 yearly)
ECHO to diagnose cardiac defects
Regular audiometry for hearing impairment
Regular eye checks
Give some causative organisms for viral meningitis
HSV
VZV
Mumps, measles
HIV
EBV
Influenza
CMV
