O&G PPQs Flashcards
Which strains of HPV does gardasil protect against?
6, 11,16,18
- Gardasil: which HPV serotype from the list does it protect against? HIV, HSV1, HSV2, HPV11, HPV29?
HPV11
UTI in first trimester of pregnancy. What would be the safest and most effective treatment? Trimethoprim, Ciprofloxacin, Doxycycline, Cefalexin, Meropenem
Cefalexin
- Amenorrhoea for 4 months – what is the best initial investigation?
Beta HCG
Girl with cystic ovaries on US and irregular menstruation. What other symptom would be the best indicator of her having polycystic ovaries? Dysmenorrhoea, Hirsutism, Obesity, Acne.
Hirsutism
Woman with PCOS. Which medication to increase fertility should be given first?
Clomiphene
Man with azoospermia. What would be the most likely cause?
Variocele
- Post-menopausal woman with a PV bleed. What ix should you do?
Outpatient USS with endometrial biopsy
- Asymptomatic woman, nulliparous, found to have a 5.4cm unilocular ovarian cyst on US, no fhx. Mgmt/Ix? USS guided cyst aspiration, laparoscopic removal of cyst, discharge and safety-net, rearrange USS in 3 months and Ca-125 follow-up
Rearrange USS in 3 months and Ca-125 follow-up?
A woman presents 8 weeks after normal vaginal delivery and second degree tear, still bleeding and mild lower pelvic pain. Diagnosis? Normal menstruation, PID, endometritis, lochia
Endometritis
- What is a 21 week USS useful for? Nuchal thickness for Down’s, congenital heart disease identification, predicting position of placenta at term
Congenital heart disease identification (anomaly scan)
What causes increased urinary volume and frequency in the first trimester? Increased GFR, pressure of uterus on bladder, glycosuria
Increased GFR?
Effect of taking Paroxetine during pregnancy on baby?
In first trimester: small risk of congenital heart defects. In third trimester: risk of persistent pulmonary hypertension of the newborn
- Woman with Nexplanon. Most likely reason for wanting to change contraceptive? Weight gain, acne, mood swings, irregular bleeding
Irregular bleeding
- 14 year old girl wants TOP, can’t/will not inform parents. What do you do?
Assess whether she is Gillick competent
- Pregnant lady being domestically abused by husband and scared to go home. What do you do in GP? Send her home and ask her to come back with husband, give her a leaflet about domestic abuse, call and arrange emergency accommodation
call and arrange emergency accommodation
- Woman has pain before periods and has been subfertile, cyst found on ovary with a ground glass appearance on USS
Endometrioma
- 70 year old lady has some spotting and says she uses some steroid cream for a “rash down there”
Vulval cancer
- Lady is on Tamoxifen, which cancer does this increase the risk of?
Endometrial cancer
Green discharge points to which condition?
Trichomonas vaginalis (visualised on wet slide microscopy)
Woman with a slow growing painless lesion on labia
Bartholin’s cyst
- Woman who has gone through menopause, had a hysterectomy. Wants HRT mainly to prevent osteoporosis and treat her hot flushes. Doesn’t want to take tablets
Continuous transdermal oestrogen
- Woman with premature ovarian failure, wants to have periods
Cyclical combined HRT
- 62 y/o woman who just wants to treat osteoporosis
Bisphosphonates
- Small painful lump inside vagina of sexually active woman
Malignancy
Bleeding/unwell post partum- causes
Tone, trauma, thrombin, tissue
SBA on what to do with a cord prolapsed
push back the presenting part of the foetus
Anorexia diagnostic criteria
Anorexia nervosa - BMI <17.5 or 15% less than expected, deliberate weight loss, distorted body image, endocrine disturbance, may also purge
Refusal to maintain 85% of expected weight
Intense fear of gaining weight
Disturbed experience of body
Amenorrhoea
Bulimia diagnostic criteria
Bullimia nervosa - binge eating, purging, body image distortion, BMI > 17.5
Binging, purging both occurring twice a week for 3 months
Self evaluation overinfluenced by weight
Disturbance does not occur exclusively during periods of AN
Cardiac malformation in Turner’s?
bicuspid aortic valve, coarctation of aorta
What situation would you use donor eggs?
POI
What do you test for in Hep B infection antenatally?
Hep B surface antigen
What is the treatment for a bartholian abscess?
Marsupilisation
Women with APH (spotting) otherwise well, what is the most important thing to rule out?
Placental abruption
What type of contraception can increase risk of osteoporosis?
Progesterone only
When to admit Hyperemesis gravidarum?
Ketones and electrolyte imbalance. Dehydrated.
What is likely to cause this man’s azoospermia?
Variocele
Someone comes in at 28w with a Hb of 10.4 what would you do?
Give oral iron supplements?
Clue cells - what diagnosis?
Bacterial vaginosis
Strawberry cervix
Trichomonas vaginalis
Painful multiple lesions on labia
Genital warts
Mother with stillborn baby, generalized oedematous when born, mother had fever at 18w with rash on trunk
Varicella zoster virus
Smear comes back as moderate dyskaroysis
CIN?
76 year old had a single brown discharge - most likely diagnosis?
Atrophic vaginitis
Mother had previous CS, sudden abdo pain and abnormal CTG
Uterine rupture
Mother with girl who doesn’t speak, what should you do?
Hearing test?
Kid fitting for over 5mins, normal glucose, what do you give?
Buccal midazolam
Dehydration + ill kid (not DKA)– weight 15kg what do you give initially?
0.9% saline IV fluid bolus (20ml/kg)
Strawberry tongue (2 possibilities)?
Scarlet fever, Kawasaki disease
Child with pruritus ani worse at night, what would you give to treat? -
Single dose of mebdenazole to whole household
Impetigo treatment
Fusidic acid
Rash not involving flexures treatment?
Zinc and castor oil?
Rash involving flexures treatment?
Clotrimazole??
Chickenpox treatment
No treatment required
Posterior fossa tumour?
Medulloblastoma
Kid with sore throat, cervical lymphadenopathy, been given antibiotics, rash comes on.
EBV
Rash that started from behind the ears and spread to trunk, parents are vegetarians and kid goes to school in north London
Measles?
Scaphoid abdomen in a baby
Congenital diaphragmatic hernia?
Someone who just started on an antipsychotic and becomes tachycardia, hyperthermia, sweating, urine drug screen negative, what is the diagnosis?
Neuroleptic malignant syndrome
Diagnosed bipolar disorder – sudden renal failure, what do you check?
Lithium levels
Starting 21 year old with depression + suicidal idealization on antidepressants, what is your follow up plan?
Follow up in 1 week
Someone with acute dystonia what would you give?
Procyclidine
Alcoholic and had previous delirious tremens and wants detox at home what would you do?
Recommend hospital detox
78yo guy has issues with organization, troubles with understanding words
Frontotemporal dementia?
Women with sudden confusion what would you do first?
Urine dipstick
Failed 2 antipsychotics – what do you give?
Clozapine
Someone who was started on haloperidol and has acute muscle spasm (acute dystonic) ?
Give procyclidine
Lady has a diagnostic laparotomy. She has suprapubic pain that not even IV paracetamol is helping. What is the likely reason?
Perforation??
Somali lady comes in doesn’t speak much English says she’s 42 weeks. Examination of abdomen suggests a 32 week uterus. What is next in management?
USS scan?
Leading cause of maternal mortality in UK?
VTE??
Child is slow to get dressed. Likes to arrange his toys in a particular way
ADHD
Child is an arsonist. Gets in fights. Attacks teachers. What is he likely to have at age 20?
Antisocial personality disorder
Neonate. Ortolani test positive. What you do?
Hip USS at 6 weeks
Child has inspiratory stridor (doesn’t explicitly state, but gives a description implying this) since birth. Likely cause?
Laryngomalacia
7 year old goes to a new school. School complains that he keeps soiling himself. What is most likely reason?
encopresis
What defines a mild learning disability? [IQ: <80/<70/<60/<50/<30]
<70
You’re a GP. Elderly person presents with a history of the classical signs of Alzheimer’s. What do you do next?
Refer to memory clinic
A person with a diagnosis of Bulimia nervosa. BMI 22. Wants to get help. Management? [CBT; CBT+ Fluoxetine; Fluoxetine; Psychoanalytic therapy]
??
Two fetal poles, one gestational sac - what type of twins?
Monoamniotic; Dichorionic
MAOi cheese reaction?
Hypertensive crisis
Child with posterior rib fractures and some other patterns of injuries
NAI
Girl not able to weight bear. Recently recovered from viral illness.
Transient synovitis
Yellow-green discharge and pain - diagnosis?
PID
Commonest type of endometrial cancer?
Endometroid adenocarcinoma
Age of smiling?
6 weeks
When should children achieve pincer grip?
12 months
28 day child with pale stools
Biliary atresia
Child at school. Complains of unusual smell. Then seems to ‘space out’. Afterwards she’s very drowsy and sleeps for a few hours in the school nurses office. She has no recollection of what happened??
Focal seizure
Redcurrent jelly stools - diagnosis?
Intussception
19 year old abdo swelling, weight gain, irregular periods usually, can’t remember when last period was, denies being sexually active. What is the first test you would do?
Pregnancy test
Woman with PCOS. Best medication to increase fertility.
Comifene
Woman with signs of premature ovarian failure. What test would be best to confirm this diagnosis: Oestradiol, Testosterone, FSH, LH
FSH
Man with azoospermia. What would be the most likely cause? Hx of mumps, hx of testicular torsion, Varicocele
Variocele
What is a 23 week USS useful for? Nuchal thickness for Down’s, congenital heart disease identification, predicting position of placenta at term..
Congenital heart disease identification
14 year old girl wants TOP, can’t/will not inform parents. What do you do?
Assess gillick competence
Pregnant lady being domestically abused by husband and scared to go home. What do you do in GP? Send her home and ask her to come back with husband, give her a leaflet about domestic abuse, call and arrange emergency accommodation
call and arrange emergency accommodation
Lady high White cell count, fever, lump in breast
Abscess
General breast tenderness - left sided, breastfeeding
Mastitis
Small painful lump inside vagina of sexually active woman
Genital wart
Small slow growing lesion on labia, pregnant lady
Bartholin’s cyst?
Kid who has acne. Topical Antibiotics don’t work. What do you give next?
Oral antibiotics + BPO
Kid with history of anal fissure - what is your first cause of action?
Inspect anal region
Kid has pain in outer ear, ear was protruding outwards, and there was a lump behind his ear.
Mastoiditis
Kid with cervical lymphadenopathy, fever, sore throat, red tongue with white spots. What does she have?
Measles
4yo kid having acute asthma attack, given iv salbutamol and hydrocortisone. Sats still low, no chest sounds on auscultation. What do you do/give next?
Call for senior help
4 month old, about to have 3 batch of primary vaccinations. Which would be a complete contraindication to having the vaccine?
currently ill with a fever of 38.5
Kid with URTI and generalised abdo tenderness
Mesenteric adenitis
Baby was born at 41 weeks via emergency C section due to foetal distress. Needed ventilation straight away. X ray showed hyper inflated lungs with areas of consolidation. What does he have??
Meconium aspiration??
Grandmother brings boy in with swollen knee. Boy’s brother died young of a minor head injury.
Haemophilia
Treatment of scabies
permethrin cream and malathion lotion
Risk of schizophrenia with family history
While the risk is 1 percent in the general population, having an FDR such as a parent or sibling with schizophrenia increases the risk to 10 percent.
The risk jumps to 50 percent if both parents have been diagnosed with schizophrenia, while the risk is 40 to 65 percent if an identical twin has been diagnosed with condition.
60 year old woman, short term memory loss, struggling to complete her normal daily tasks, ataxia and dysphagia. What would you see on MRI? Hippocampal atrophy, lacunar lesions, white matter lesions, frontotemporal atrophy, general signs concordant with old age
Hippocampal atrophy??
What is raised in anorexia nervosa?
growth hormone,glucose, salivaryglands,cortisol,cholesterol,carotinaemia
What signifies onset of active labour?
4cm dilatation
Woman has cervical cancer, is a smoker, hasnt had a smear for 8 years - what is the most likely contibuting factor?
No smears
Woman with white discharge and itch. Which treatment
Clotrimazole pessary
Pregnant woman with itchy feet, what investigation?
LFTs
Results show azoospermia. How should they be managed?
IVF with ICSI
Ground glass appearance of ovarian cyst
serous cystadenoma?
Lady is on Tamoxifen, which cancer does this increase the risk of?
Endometrial??
A newborn appears to be in severe respiratory distress and appears blue. Despite being given high flow O2, his saturations remain at 65%.
What is the next best step to take with regards to his management?
Chest X-Ray
Infusion of Prostaglandin
Surgery
Indomethacin
Prostaglandin E1??
ADHD treatment
Parental training, methylphenidate, clonidine
What is the most important thing to look at in follow up of HSP?
Urine protein and RBCs
15 year old boy with short stature. Passing urine 10 times a day with no dysuria. Pale with heart rate at 78bpm, blood pressure at 158/88 and respiratory rate at 14. What is the likely diagnosis?
Diabetes??
6 year old child with 24 hour history of left peri-orbital swelling. Had an upper respiratory tract infection last week. Left proptosis, visual acuity was normal and had a fever of 38.9. What is the best diagnostic investigation?
CT of nasal orbits, USS of nasal orbits, nasal endoscopy, intraocular pressure measurement, plain x-ray of nasal sinus
CT of nasal orbits
Boy with itchy bottom, what do you prescribe?
Mebdenazole
Child with 6m of loose stools. Passed one hard blood streaked stool 10 days ago. What investigation?
do nothing
Infant with episodes of throwing arms forward with fists clenched.
Infantile spasm?
Child with fever, white exudate on one tonsil, diagnosis? Tonsillitis, Quinsy, diphtheria
??
Child with episodes of smelling strange things, hard to communicate with during these episodes, falls asleep for an hour after and doesn’t remember anything. Diagnosis?
Focal seizure, absence seizure, tonic clonic, narcolepsy
Focal seizure
Mother worried 5 year old? son has autism. Which would most support a diagnosis of autism? Child doesn’t make eye contact, child didn’t speak first words until 2 years old and goes to a speech and language therapist, brings a particular toy with him everywhere
child didn’t speak first words until 2 years old and goes to a speech and language therapist
Mother complains her young child is a fussy eater. She eats soft foods and drinks a lot of milk. Also has been feeling tired recently. Diagnosis?
Iron deficiency anaemia
4 year old girl with a high fever that was followed by a rash which has small white dots on a red base. What is the most likely Dx?
Roseola infantum
Child has an URTI 2 weeks ago. Has now developed a rash over the back of the legs along with joint and abdominal pain.
HSP
Nappy rash with satellite lesions treatment?
1% hydrocortisone or anti-fungal cream
Kid given dexamethasone for croup 12 hours ago by GP, was stable and well with good sats but still mild stridor. What else do you give?
Repeat steroids
Hypochloraemic hypokalaemic pH shown, with some clinical information. What is the initial management for it?
Correct electrolyte imbalance
Voraciously hungry kid, hypotonia and almond eyes what was the diagnosis? Initial problems feeding (big give away for prader-willi) and almond eyes.
Prader-Willi
Kid who had rashes which had crusted over and he was also scratching them and now he had a peak fever and cool peripheries. What is the cause for his acute presentation?
Varicella zoster viraemia
3 year old kid with unilateral nasal discharge with bleeding and crust or something like that, What was the most likely cause
Foreign body insertion
Neonate with some cardio problem. Systolic murmur loudest at the left sternal edge 2/6
VSD
Kid who basically had ADHD. What is the management? CBT, Parental training, methylphenidate.
Parental training
14 year old kid who thieves, got into fights (basically conduct disorder). What is 1st Mx? Multisystemic (family) therapy, CBT, DBT, psychodynamic therapy
Multisystemic (family) therapy
Child who has a hx of very dry skin, rash over arms, getting worse & spreading to ?extensor surfaces. Sister has itchy rash on ankles and wrists. (Sounds like Eczema) What would be the management? Fusidic acid, emollients+1% hydrocortisone, permethrin cream
emollients+1% hydrocortisone
Hip pain on exercise and climbing stairs. Prolonged history, otherwise well. Perthes disease, osgood-schlater, septic arthritis
Perthes disease
23yo female child with intermittent limp, otherwise well. DDH, irritable hip, osgood-schlater, septic arthritis
DDH
Uncle gets TB, kid lives with him, Mantoux test showed a number between 10-14mm for the result. What should you do? Watch and wait, give Isoniazid prophylaxis, Start anti-TB treatment (the kid has TB with those diameters) give BCG vaccine, prophylactic isoniazid etc.u
Start anti-TB treatment (the kid has TB with those diameters
Precocious puberty (5yo and has sparse axillary and pubic hair as well as breast bud development) and high centile growth parents are along some lower centile. What definitive diagnostic test do you do? Bone age, gonadotropin stimulation test, MRI scan of pituitary fossa
Gonadotropin stimulation test
Cerebral Palsy (described hemiplegic weakness with brisk reflexes), what area of the brain is affected? Motor cortex, basal ganglia, pyramidal tracts, cerebellum, internal capsule
? Motor cortex
Kid with 2cm x 2cm neck mass (inframandibular) on L side, painful, neck mass, reactive neutrophils - blood film shows: toxic left shift with reactive neutrophilia ?
Lymphadenitis
Newborn with purple spot on face [Sturg-Weber], what is the next best approach? Discharge to Gp follow up, Medical photography, Clotting studies, Send urgently to A&E [MRI probably was a choice but not sure - don’t think so]
Medical photography?
Kid needs fluids, but you can’t get standard IV access. Where do you go? Jugular, brachial, carotid, Intraosseous
Intraosseous
HIV with undetectable viral load. what is contraindicated in labour?
Foetal blood sampling
60 year old woman with PMB and superficial dyspareunia, what is the MOST LIKELY diagnosis?
atrophic vaginitis
Mother had rupture of membranes at like 32 weeks. What do you give her? IM dexamethasone, magnesium sulphate, something that began with c
Dexamethasone
Babies head comes out but it kinda goes back in. What is the cause?
Shoulder dystocia
Woman with painful breast after giving birth. She’s breast-feeding - think she had abscess secondary to mastitis. Surgical excision, aspirate and ?culture, Ciprofloxacin
Ciprofloxacin
Woman with blocked tubes, blocked tubes on hysterosalpingogram, what treatment should you do for fertility? IVF, IUI, ICSI.
IVF
Poorly controlled diabetic mother, her newborn has an abnormal asymmetric Moro reflex - what’s wrong? (secondary to probably shoulder dystocia coz of diabetes) HIE, fracture of humerus, brachial plexus injury??
brachial plexus injury
What procedure is contra-indicated in HIV pregnant woman?
Fetal blood sampling
Woman at term has just SROM’d, transverse lie clear liquid but fetal distress, why?
Cord prolapse
Old man who was ex-accountant has like MMSE 28/30, getting somewhat forgetful and needs wife to do his finances as he gets confused, but manages all other daily activities. what’s the diagnosis?
Mild cognitive impairment
Some 25 year old students with asthma/diabetes, stressed about exams for 6 weeks and his exams are coming up in like 2 weeks. What do you do? watch and wait, CBT, beta blocker, benzo, sertraline
Give benzos
Atypical anorexia nervosa?
All the symptoms but BMI >18.5
50 year old guy wanders in screaming he sees ants and tiny men running around (buzzword), hot?, sweating, dishevelled looking - delirium tremens, cocaine ingestion, Wernicke’s
Delirium tremens
Dude with LBD, given a drug that makes him worse, what drug?
Haloperidol
Child has classic symptoms of ADHD, how do you manage? Methlyephenidate, Family Therapy or CBT
Family Therapy (first line ALWAYS)
Some with dilated pupils, urinary retention, obs normal-ish - cause of overdose? TCA/amytriptiline, benzos, opioids, SSRI
TCA?
50y lady fell over gardening, comes in with paralysis of leg, no medical cause found?
Conversion disorder
Most common congenital infection in the UK?
CMV
Investigations for ADHD:
Investigations:
Diagnosis only by a clinical psychiatrist
Includes psychometric testing
Include information from parents and teachers to ensure symptoms present in more than one aspect of life
Connor’s assessment scale may be useful
Educational psychologist assessment
ADHD treatment
Stimulants, such as methylphenidate or dexamphetamine, and non-stimulants, such as atomoxetine, reduce excessive motor activity and improve attention on task and focused behaviour
Follow up in ADHD medication
Height and weight measured in children every 6 months (3 months if under 10)
Measure CVD every 6 months
Sexual dysfunction, seizures, tics, sleep disturbances
Adherence difficult
Review treatment at least once a year
Questionnaires for alcohol
Assess the pattern and severity of the alcohol misuse (AUDIT)
LDQ or SADQ for dependence
CIWA-Ar for severity of withdrawal
APQ for the nature and extent of the problems arising from alcohol misuse.
Consider MMSE for help in treatment planning
Alcohol detoxification management
Detoxification:
Chlordiazepoxide to replace alcohol and prevent withdrawal symptoms
They are gradually withdrawn and stopped.
Thiamine: prescribed as prophylaxis against Wernicke’s encephalopathy.
Given parenterally (IM or IV) since it is poorly absorbed in the gut.
Symptom-led assessment is used, where medication is given according to observed withdrawal symptoms.
Outpatient detoxification indications
Clinical evidence of alcohol withdrawal
Hx of alcohol dependence
Alcohol use greater than 10 units per day over the past 10 days
Inpatient detoxification indications
Acute confusion or symptoms of Wernicke-Korsakoff syndrome
Hx of seizures or delirium during withdrawals, comorbidities, malnutrition
Suicide risk high, history of polydrug use, comorbidities
Lack of stable support in community
Alcohol relapse prevention
Psychological: CBT and problem-solving therapies
Medical: Acamprosate (anti-craving): enhanced GABA transmission in brain
S/E: pruritus, GI upset, rash
Disulfiram (Antabuse mimics flush reaction to alcohol)
Irreversible inhibitor of acetaldehyde dehydrogenase prescribed once abstinence is achieved
S/E: headache, halitosis, rarely liver toxicity
Discuss oppositional defiant disorder.
Children should be younger than 10 years old and exhibit four behaviours from either the list below or up to two from the 15 item conduct disorder list above and the rest from the list below:
Has unusually frequent or severe temper tantrums for his or her developmental level
Often argues with adults.
Often actively refuses adults’ requests or defies rules.
Often, apparently deliberately, does things that annoy other people.
Often blames others for his or her own mistakes or misbehaviour.
Often ‘touchy’ or easily annoyed by others.
Often angry, resentful or spiteful
Pharmacological treatment for conduct disorder?
Consider risperidone for the short-term management of severely aggressive behaviour in young people with a conduct disorder who have problems with explosive anger and severe emotional dysregulation and who have not responded to psychosocial interventions.
Alzheimer’s (4 As)
Amnesia, aphasia, agnosia, apraxia
Signs of frontotemporal dementia?
Change in behaviour and language difficulties
Treatment of miscarriage?
Give anti-emetics and pain relief
Follow up after medical miscarriage
Advise women to take a urine pregnancy test 3 weeks after medical management of miscarriage unless they experience worsening symptoms, in which case advise them to return to the healthcare professional responsible for providing their medical management.
Follow up of expectant management for miscarriage <6 weeks without pain
To repeat a urine pregnancy test after 7–10 days and to return if it is positive
A negative pregnancy test means that the pregnancy has miscarried
To return if their symptoms continue or worsen.
Manual vacuum aspiration is done where and when?
Before 14 weeks? Under LA in an outpatient or clinic setting
Causes of Recurrent miscarriage = 3+ consecutive miscarriages?
Antiphospholipid syndrome
Endocrine disorders: poorly controlled diabetes mellitus/thyroid disorders.
Polycystic ovarian syndrome
Uterine abnormality: e.g. uterine septum
Pparental chromosomal abnormalities
Smoking
Investigations for recurrent miscarriage?
Anti-cardiolipin antibodies, TFTs, HbA1c, prolactin, FSH/LH, transvaginal USS to rule out uterine abnormality, parental chromosome abnormalities, discuss lifestyle
What to do if bleeding with CRL<7mm and no fetal heartbeat?
Refer for second opinion or re-scan in 1 week
Questions in TOP?
Safeguarding, long-term contraception, STI screen,
Medical treatment of TOP?
Oral mifepristone followed by misoprostol 24-48 hours later
Progesterone antagonist + prostaglandin
Pain relief for medical abortion
NSAIDS
N.B. If history of asthma can’t use prostaglandins
4-9w = mifepristone and one dose of misoprostol
9-24w = mifepristone and multiple doses of misoprostol
13-24w = surgical management of TOP?
Dilatation and evacuation
Diagnostic Criteria for LD:
Impairment of intellectual functioning
IQ <70 (2 SD from the mean)
Impairment in social or adaptive functioning
AoDL
Present before 18 years of age
IQ parameters of LD:
IQ:
50-69 = mild
35-49 = moderate
20-34 = severe
0-20 = profound
Most common inherited cause of LD?
Fragile X syndrome
What is naltrexone?
Naltrexone (anti-craving): reduces total alcohol consumed and number of drinking days;
S/E: anxiety, headache, fatigue, flu-like symptoms, GI upset, sleep disturbance
Questionnaires for PTSD
Impact of Event Scale (children’s version as well)
Post-traumatic Diagnostic Scale
Davidson Trauma Scale
PTSD Checklist
What is the prognosis for the first instance of PP?
What is the prognosis for the first instance of PP?
Should resolve in 6-12 weeks
High risk of suicide
Risk of reoccurrence in subsequent pregnancies ~50%
What would be the main red flags for PP?
Feelings of harming self/ baby
Sudden change in mood/ mental state
Sudden change in attachment
Drugs that can cause psychosis
anticonvulsants, high-dose corticosteroids, levodopa and dopamine agonists, or opioids
Treatment for GAD?
Step 1 - education
Step 2 - low intensity psychological treatment
Step 3 - high intensity psychological treatment OR drug treatment
15 year old boy with short stature. Passing urine 10 times a day with no dysuria. Pale with heart rate at 78bpm, blood pressure at 158/88 and respiratory rate at 14. What is the likely diagnosis? Chronic renal failure, diabetes mellitus, nephroblastoma, acute pyelonephritis, urinary tract infection
Chronic renal failure
Child with fever, white exudate on one tonsil, diagnosis? Tonsillitis, Quinsy, diphtheria
Quinsy
Amenorrhoea for 4 months - what do u do?
Beta HCG
Asymptomatic woman, nulliparous, found to have a 5.4cm unilocular ovarian cyst on US, no fhx. Mgmt/Ix? USS guided cyst taspiration, laparoscopic removal of cyst, discharge and safety-net, rearrange USS in 3 months and Ca125 follow-up
rearrange USS in 3 months and Ca125 follow-up
What causes increased urinary volume and frequency in the first trimester?
Increased GFR
Small slow growing lesion on labia, pregnant lady
Genital warts
Prem baby, resp distress, CXR looks like ground glass.
Respiratory distress syndrome (surfactant deficiency)
80 year old man with new onset dementia, needs MRI but refuses. You need someone to make decision for him.
Independent mental health advocate
Schizophrenia risk with family history
(1st degree relative is 1/10, a twin is 50%)
Guy on medication for schizophrenia get muscle rigidity, altered consciousness, high blood pressure, tachycardia. Mgmt?
ITU admission
Man with treatment resistant schizophrenia on clozapine, recently stopped smoking. High level of clozapine now. Most likely consequence?
Seizures
How is removal of foreign body done?
Removal of foreign body under bronchoscope-guidance + antibiotics + bronchodilators. Then had to explain this to mum. Bronchoscopy
What are the causes of oligohydramnios?
Renal agenesis
Multicystic kidneys
Posterior urethral valves
Placental insufficiency and FGR
Maternal drugs (NSAIDS)
Chromosomal abnormalities
Post-dates pregnancy
PPROM
Amnion nodosum
Intrauterine infection
Criteria for learning disability
Lower intellectual ability (usually an IQ of less than 70). Significant impairment of social or adaptive functioning. Onset in childhood.
What is the definition of a small for dates baby? How do we diagnose?
The estimated fetal weight or abdominal circumference of the fetus <10th centile for gestation – diagnosed on ultrasound
What is the most common cause of SGA?
Constitutionally small (50-70% cases)
Investigations for SGA
Screening for toxoplasmosis, CMV (malaria, syphilis if high risk travel)
Refer for umbilical artery surveillance every 2 weeks from 26-28 weeks
Measure EFW and AC every 2 weeks
Other surveillance: amniotic fluid maximum pool depth (<2cm = oligohydramnios), computerised CTG
In SGA, At 31 weeks umbilical artery Doppler shows absent end diastolic flow – what next?
Continue UA surveillance daily and AC/EFW weekly
If DV Doppler is abnormal recommend delivery
If DV Doppler is normal, still recommend delivery by 32 weeks
Give steroids
What is a DV doppler?
The ductus venosus (DV) is an intrahepatic end-part of the umbilical vein. Inappropriate first trimester DV Doppler blood flow patterns correspond to a higher risk of chromosomal abnormalities.
If small for dates was picked up earlier (18-20 week scan) what investigations might you do?
Detailed fetal anatomical survey and uterine artery Doppler by fetal medicine specialist
Karyotyping if structural abnormalities or picked up before 23 weeks (may have trisomy 18 or triploidy)
Cessation of smoking in pregnancy counselling:
Give her NHS Pregnancy Smoking Helpline
Refer to NHS Stop Smoking Services: structured self-help and support
NRT not recommended in pregnancy but can be given only if mother has stopped smoking
Offer CBT/motivational interviewing
Risks of smoking:
Miscarriage
Preterm delivery
Stillbirth
IUGR
Abruption
SIDS
Reduction in breast milk production
Jitteriness in babies in perinatal period (nicotine withdrawal)
More respiratory childhood infections
