MSC practice paper (O&G, Paeds, Psych) Flashcards
An 18 year old woman is 19 weeks pregnant. An ultrasound scan shows her baby has anencephaly. She wants to discuss her options with regards to termination of pregnancy.
When will termination of this pregnancy be legally permitted?
A. After spontaneous fetal death
B. At any time during the pregnancy
C. Before 20 weeks’ gestation
D. Before 24 weeks’ gestation
E. Before 28 weeks’ gestation
B. At any time during the pregnancy
The law is the UK is that the usual limit for termination of pregnancy is 24 weeks’ gestation. However, anacephaly is a fetal anomaly that inevitably results in the death of the fetus. This, or a risk of serious harm to the woman, means that termination is legal at any time.
A 29 year old woman visits her GP with a heavy sensation in her vagina when exercising. She is aware of a bulge in her vagina, sometimes associated with a desire to void urine. She had a vaginal delivery 2 years ago.
There is some laxity of the anterior vaginal wall, but this does not descend to the introitus on straining. Urine culture is negative.
Which is the most appropriate management plan?
A. Oxybutinin hydrochloride
B. Pelvic floor exercises
C. Refer for urodynamic testing
D. Refer to urogynaecology clinic
E. Ultrasound scan of pelvis
B. Pelvic floor exercises
The most appropriate management plan for this patient with symptoms of pelvic organ prolapse is pelvic floor exercises from the physiotherapists. The GP has examined the patient and she has a first degree anterior prolapse. The physios will also make a further assessment including a thorough examination of the pelvic floor, to establish the extent of the prolapse and any associated symptoms. This will inform the choice of treatment, which will nearly always include conservative measures such as pelvic floor exercises. Referral to urogynaecology clinic is usually needed if there is a severe prolapse e.g. 3rd degree or severe urinary bowel incontinence or failed PFEs when management may include more invasive options such as surgical repair. Oxybutinin hydrochloride is used in the management of urgency urinary incontinence, which is not the main symptom in this patient. Pelvic floor exercises can be recommended as part of the management of pelvic organ prolapse, but in the absence of a full assessment and diagnosis, their effectiveness may be limited. Urodynamic testing and ultrasound scan of the pelvis may be considered as part of the overall management plan, but only if referral to a specialist clinic is needed.
A 19 month old girl has been able to sit unsupported for 1 month. She can speak 2 words and has just started to feed herself using her fingers. She was born at 30 weeks’ gestation.
Which is the best description of her current development?
A. Fine motor delay
B. Gross developmental delay
C. Gross motor delay
D. Mild developmental delay
E. Normal development
C. Gross motor delay
A child should be able to sit unsupported by 7 months of age; speak at least 2 words and feed themselves using fingers by 12 months of age. The fact that she was born at 30 weeks’ gestation i.e. 10 weeks premature, should be taken into consideration when assessing her development. Development may be delayed by approximately 10 weeks, but this does not explain the delay seen here.
A mother gives her 6 month old baby girl formula milk for the first time. Within minutes, the baby vomits and develops an erythematous rash over her lips and chin, which takes 1 hour to subside. The following week, the mother drips a couple of drops of formula milk onto the baby’s arm. The baby develops an erythematous rash over the arm within 1 minute.
The mother is returning to work and does not wish to continue breastfeeding or expressing milk.
Which is the best management option?
A. Goat’s milk
B. Hydrolysed formula
C. Lactose free formula
D. Latex free teat
E. Soya milk
B. Hydrolysed formula
The most appropriate management option in this case is hydrolysed formula. The infant is showing signs of a possible cow’s milk protein allergy, with both vomiting and an erythematous rash following the ingestion of formula milk. Hydrolysed formula is recommended as a substitute for cow’s milk- based formula in infants with a suspected cow’s milk protein allergy, as it has been partially or completely broken down to reduce the allergenicity of the proteins. Goat’s milk is not recommended for infants as it has similar protein structures to cow’s milk and can cause similar allergic reactions. Lactose-free formula is not necessary unless the infant has a diagnosed lactose intolerance, which is rare in infants. A latex-free teat may be needed if the infant has a latex allergy, but this is not relevant in this case. Soya milk is not recommended for infants under 6 months of age, as it can interfere with the absorption of important nutrients and may also cause an allergic reaction.
A 28 year old woman is admitted with a sudden onset of abdominal pain and vaginal bleeding. She is 38 weeks pregnant.
Her pulse rate is 120 bpm and BP 110/80 mmHg. She has a tender abdomen. The fetal heart rate is 170 bpm.
Which is the most likely diagnosis?
A. Necrosis of a fibroid
B. Placenta praevia
C. Placental abruption
D. Pre-term labour
E. Uterine rupture
C. Placental abruption
The most likely diagnosis in this scenario is placental abruption, which is a medical emergency. The sudden onset of abdominal pain and vaginal bleeding along with the tender abdomen and tachycardia are suggestive of this diagnosis. The high fetal heart rate may indicate fetal distress. Prompt evaluation and management are necessary to optimise the chances of a successful outcome for both the mother and the baby.
A 25 year old nulliparous woman with an uncomplicated pregnancy attends for induction of labour at 41 weeks.
Examination reveals the head is engaged; the cervix is posterior, 2cm long and the os is closed.
Which is the most appropriate method of induction?
A. Endovaginal prostaglandin gel
B. Membrane sweep
C. Oxytocin infusion
D. Oxytocin infusion and amniotomy
E. Progesterone suppository
A. Endovaginal prostaglandin gel
Endovaginal prostaglandin gel is the most appropriate method of induction in this scenario. The woman is at term and the head is engaged, indicating that the fetal head is in the pelvis. Cervical assessment reveals that the cervix is unfavourable for induction, with a posterior position, a length of 2 cm, and a closed os. Endovaginal prostaglandin gel is a method of cervical ripening, and reserved for cases in which the cervix is unfavourable, and there is a need to ripen the cervix before induction. Membrane sweeps encourage normal labour but are not a recognised induction method on their own. Oxytocin infusion and amniotomy is unlikely to be an an effective method of induction in this situation. The cervix is closed making ARM difficult if not impossible without cervical ripening oxytocin cannot be used without amniotomy. Progesterone suppositories are used to prevent preterm labour, and they are not indicated for induction of labour at term.
A 60 year old man believes that the government has been monitoring him for 10 years, despite him repeatedly writing to the Prime Minister. His beliefs are present whatever his mood, and he has never heard voices when nobody else is around.
Which is the most likely diagnosis?
A. Anankastic personality disorder
B. Delusional disorder
C. Depression with psychosis
D. Paranoid schizophrenia
E. Schizoid personality disorder
B. Delusional disorder
Based on the given information, the most likely diagnosis is delusional disorder. The delusions have not escalated or changed for significant period and are considered to be non-bizarre i.e., situations that are not real but also not impossible. These beliefs began 10 years old so this is not a personality disorder as symptoms were not present since late adolescence. There are no other symptoms commonly seen in schizophrenia, such as hearing voices or experiencing disorganised speech and behaviour.
A 6 hour old term baby boy is grunting and cyanosed. He has been struggling to feed.
His temperature is 36.8°C, pulse rate 190 bpm (120-160), respiratory rate 60 breaths per minute (30-60) and oxygen saturation 82% breathing air. His oxygen saturation does not improve significantly breathing high flow oxygen. He has a loud single second heart sound and a systolic murmur.
He is treated with intravenous fluids and antibiotics. Which is the most appropriate next medication?
A. Alprostadil
B. Ibuprofen
C. Indometacin
D. Sildenafil
E. Surfactant
A. Alprostadil
Based on the symptoms described, the most likely diagnosis for this baby boy is a congenital heart defect. The loud single second heart sound and systolic murmur suggest a possible ventricular septal defect (VSD) or patent ductus arteriosus (PDA). The grunting and cyanosis, along with the low oxygen saturation that does not improve with high flow oxygen, suggest that the baby is experiencing significant respiratory distress. Therefore, the most appropriate next medication would be alprostadil, a prostaglandin E1 analogue that helps maintain patency of the ductus arteriosus and improves blood flow to the lungs. This medication is commonly used in neonates with critical congenital heart defects to help stabilise their condition while further diagnostic tests and management can be planned. Ibuprofen and indometacin are both nonsteroidal anti-inflammatory drugs that are used to treat patent ductus arteriosus, but they are not appropriate in this case as they would cause closure of the ductus arteriosus, exacerbating the baby’s symptoms. Sildenafil is a medication used to treat pulmonary hypertension, which can occur in neonates with congenital heart defects, but it is not the most appropriate initial medication in this case. Surfactant is a medication used to treat respiratory distress syndrome, which is not the primary diagnosis in this case.
A 5 year old girl is brought to her GP with a rash over her arms that has been gradually worsening over the past month. Her mother reports that she seems more tired than usual.
She has a petechial rash over both forearms, with some petechiae over her left anterior chest. She is pale and has hepatosplenomegaly.
Which is the most appropriate management option?
A. Administer intramuscular benzylpenicillin sodium and send her to hospital in an ambulance
B. Prescribe a course of prednisolone and review in 3 days
C. Refer her for a routine appointment in the general paediatric clinic
D. Refer her urgently to the paediatric assessment unit
E. Take a full blood count and blood film and see her within 48 h
D. Refer her urgently to the paediatric assessment unit
The presence of a petechial rash, hepatosplenomegaly, and tiredness in a child should raise suspicion of a serious underlying condition, such as leukaemia or other haematological disorders. Urgent referral to the paediatric assessment unit is necessary to ensure prompt diagnosis and treatment. Intramuscular benzylpenicillin sodium is not appropriate in this case, as it is unlikely to address the underlying condition. Prednisolone is also not appropriate, as it is not indicated for the management of petechial rash and hepatosplenomegaly. Referral to a general paediatric clinic is not urgent enough, given the severity of the symptoms, and a full blood count and blood film should be taken urgently, but this should be done in the context of urgent referral to the paediatric assessment unit.
A 9 month old baby boy is brought to his GP with 4 days of coryzal symptoms, intermittent fever, coughing and wheezing. He has been taking smaller feeds for the past 2 days and was unsettled last night. He is alert, there is no rash and he is drooling. He as adequate oral intake. His mother has given him paracetamol suspension.
His temperature is 38.2°C, capillary return 1 second, pulse rate 148 bpm (80- 160), respiratory rate 60 breaths per minute (30-60) and oxygen saturation 97% in air. He has widespread wheeze and crackles, and his ears and throat are normal.
Which is the most appropriate next step in management?
A. Admission to paediatric ward
B. Prescribe oral doxycycline
C. Prescribe oral co-amoxiclav
D. Reassure and give safety netting advice
E. Give nebulised salbutamol and review
D. Reassure and give safety netting advice
The presentation of this baby is consistent with bronchiolitis. The most appropriate next step in management would be to reassure and give safety netting advice. Admission to paediatric ward may be considered in severe cases or if the baby is unable to take oral fluids, but is not necessary in this case. Prescribing oral doxycycline is not appropriate as doxycycline is contraindicated in children under 12 years of age due to the risk of tooth discolouration. Prescribing oral co-amoxiclav is not appropriate as antibiotics are not routinely recommended in the management of bronchiolitis, which is usually caused by a viral infection. Reassurance and safety netting advice is important in all cases. This baby has a low grade fever but the other observations are all within normal range so there is no indication for any other intervention at present. Giving nebulised salbutamol and review would be indicated if observations were outside the normal range or if the baby was significantly distressed, not feeding etc.
A 36 year old woman and her partner have been trying to conceive for the last 18 months. Neither has ever attained a pregnancy before. Both are medically fit and well and have no surgical history. Her periods are every 38-45 days. Both smoke 5-10 cigarettes per day and drink occasionally at the weekend. Examination is unremarkable in both.
Which is the most likely cause of their inability to conceive?
A. Abnormal semen
B. Anovulatory cycles
C. Parental smoking
D. Unexplained subfertility
E. Uterine tube blockage
B. Anovulatory cycles
Based on the given information, the most likely cause of their inability to conceive is anovulatory cycles. The woman’s menstrual cycle is longer than the normal range of 21-32 days, which suggests that she may not be ovulating regularly. The absence of any other medical conditions or abnormalities in either partner suggests that anovulation is the most likely cause of their infertility.
A 45 year old man has a tremor that has worsened over several weeks. He has a history of schizophrenia and is taking haloperidol.
He has bilateral tremor and cog-wheel rigidity in his upper limbs. Which is the most appropriate treatment to manage his symptoms?
A. Co-beneldopa
B. Entacapone
C. Pramipexole
D. Procyclidine hydrochloride
E. Selegiline hydrochloride
D. Procyclidine hydrochloride
Procyclidine is an antispasmodic drug and muscarinic antagonist that crosses the blood-brain barrier and is used in the treatment of drug-induced extrapyramidal disorders and in parkinsonism. Here Co- Benedopa can be used to treat Parkinson’s disease but not EPSE. Drug-induced parkinsonism is likely the most common drug-induced movement disorder and one of the most common nondegenerative causes of parkinsonism. Any medication that interferes with dopamine transmission may cause parkinsonism. Haloperidol is a dopamine receptor blocking agent.
A 25 year old man develops a muscle contraction in his neck causing pain and an involuntary rotation of his neck. He was admitted to the psychiatric unit 24 hours ago with persecutory delusions, agitation, and auditory hallucinations. He has been given risperidone since admission.
Which side effect is he experiencing?
A. Akathisia
B. Autonomic instability
C. Dystonia
D. Parkinsonism
E. Tardive dyskinesia
C. Dystonia
The patient is exhibiting symptoms of acute dystonia, which is a side effect of antipsychotic medication such as risperidone. It is characterised by muscle spasms and contractions, often in the neck and facial muscles. Treatment includes anticholinergic medication such as benztropine or diphenhydramine.
