MMF Practice Paper

Question 1

Do patients with previously identified GBS require antibiotic prophylaxis for a planned C section?

Answer 1

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

Question 2

What is the antibiotic of choice for GBS prophylaxis? When is it given?

Answer 2

IV Benzylpenicillin

previous baby with GBS / previous colonisation

and in labour / has ruptured membranes

Question 3

What can be given for GBS prophylaxis in patients with penicillin allergies?

Answer 3

IV Cefuroxime

Question 4

Give some risk factors for reduced fetal movements

Answer 4

distraction
obesity
anterior placental position
polyhydramnios
alcohol, benzodiazapines
SGA baby

Question 5

How should RFM beyond 28 weeks be investigated?

Answer 5

handheld doppler

no heartbeat = immediate USS
heartbeat = CTG for 20 minutes

Question 6

At what point should a woman be referred if she has not yet felt baby move?

Answer 6

24 weeks

refer to maternal-fetal medicine unit

Question 7

Give some risk factors for retinal detachment

Answer 7

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

Question 8

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

Answer 8

High EPO

This patient has polycythaemia and is likely to have LOW EPO due to negative feedback from his high Hb

Question 9

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?

Answer 9

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

Question 10

Which of the following documents is legally binding?

Advanced Statement
ReSPECT Form
Advanced Decision to Refuse Treatment
DNACPR Form

Answer 10

An Advanced Decision to Refuse Treatment - signed by the patient, dated and witnessed

Question 11

What is involved in calculating a patient’s Waterlow Score?

Answer 11

Gender
Age group
BMI
Skin type
Mobility
Continence
Recent weight loss
Appetite
Tissue malnutrition
Neurological deficit
Major surgery or trauma
Medication

Question 12

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

Answer 12

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

Question 13

What is continuing care?

Answer 13

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

Question 14

What is the discharge to assess process?

Answer 14

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

Question 15

What is interim care?

Answer 15

in-home support on a temporary basis

Question 16

Give some maternal complications of diabetes during pregnancy

Answer 16

Higher risk of hypo/hyperglycaemia
Pre-eclampsia
Pre-term labour
Need for instrumental delivery/C-section/induction of labour
Miscarriage
Progression of retinopathy/nephropathy

Question 17

Give some fetal complications of gestational diabetes

Answer 17

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

Question 18

Give 3 things that should be done in the management of a diabetic woman who is trying to conceive

Answer 18

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

Question 19

Give 4 clinical features of pre-eclampsia

Answer 19

Blurred vision
Abdominal pain
Nausea/vomiting
Swelling of hands/face/feet

Question 20

Give some contraindications to VBAC

Answer 20

Previous uterine rupture
2 or more previous C sections (relative contraindication)
Classical Caesarean scar
Contraindications to labour e.g. major placenta previa

Question 21

What findings on USS point towards a diagnosis of PCOS?

Answer 21

polycystic ovaries on ultrasound scan (defined as the presence of ≥ 12 follicles in one or both ovaries and/or increased ovarian volume > 10 cm³)

Question 22

Give some causes of sudden loss of vision

Answer 22

Retinal detachment
Amaurosis Fugax
Vitreous haemorrhage
CRAO/CRVO

Question 23

What may be seen on a CXR of a patient with lung cancer?

Answer 23

multiple opacifications
hilar enlargement
unilateral pleural effusion
consolidation / collapse

Question 24

Other than chemotherapy, give 4 medical interventions that could be done to support a child with ALL

Answer 24

blood transfusion for low Hb
antiemetics
antibiotics if neutropenic
nutritional support and fluids

Question 25

State 4 signs or symptoms of subarachnoid haemorrhage other than thunderclap headache

Answer 25

LOC
Neck stiffness/ meningism
Photophobia
Nausea/vomiting
Seizures
Ptosis
Vision changes (diplopia), vision loss
Agitation/ behavioural change
Focal neurological deficits

Question 26

List 3 (short or long term) complications of subarachnoid haemorrhage

Answer 26

Rebleed
Hydrocephalus
Increased ICP/ brain herniation
Cerebral infarct
Vasospasm
Seizures

Question 27

Give 3 features that can be used to prognosticate in SAH

Answer 27

conscious level on admission
age
amount of blood visible on CT head

Question 28

How can a confirmed SAH be managed?

Answer 28

best rest, analgesia, reveral of anticoagulation
nimodipine to prevent vasospasm
coiling or clipping within 24 hours

Question 29

If antibiotics are indicated in acute otitis media what is given?

Answer 29

PO amoxicillin for 5-7 days

Question 30

How should a patient with suspected melanoma be managed?

Answer 30

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

Question 31

What is the most common type of malignant melanoma?

Answer 31

superficial spreading malignant melanoma

Question 32

Which type of malignant melanoma is seen more frequently in POC?

Answer 32

Acral lentiginous melanoma

Question 33

List some non-pharmacological interventions you could use to support a delirious patient

Answer 33

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

Question 34

Give some complications of poorly controlled delirium

Answer 34

Falls risk
Increased risk of aspiration pneumonia
Increased risk of dementia in the future
Affects patient independence and confidence

Question 35

Other than diarrhoea and weight loss, suggest some presenting features of coeliac disease

Answer 35

Failure to thrive
Fatigue
Mouth ulcers
Dermatitis herpetiformis
Peripheral neuropathy
Cerebellar ataxia
Epilepsy

Question 36

List some follow up investigations that are required for children with Down’s syndrome

Answer 36

Regular thyroid checks (2 yearly)
ECHO to diagnose cardiac defects
Regular audiometry for hearing impairment
Regular eye checks

Question 37

Give some causative organisms for viral meningitis

Answer 37

HSV
VZV
Mumps, measles
HIV
EBV
Influenza
CMV