Past Paper topics Flashcards
What are the different UKMEC levels?
What are the UKMEC levels for a 35 yo woman who smokes?
If <35 and
* smoking <15/ day: 3
* Smoking >15/ day: 4
How does Obesity change UKMEC for the COCP
If BMI 30-34: 2
IF >35: 3
What is the UKMEC criteria for COCP with current or personal history of VTE?
4
What contraception can be used in breastfeeding women 0-6 weeks postpartum?
IUS + IUD (if inserted <48h OR >4 Weeks)
Progresterone only implant
Progesterone only Pill
+ Depot progesterone (UKMEC 2)
What contraception can be used in breastfeeding women >6 Weeks?
Essentiall all but
- COCP UKMEC 2 if 6 weeks-6 months
What is the recomendation for administration of anti-D <12 weeks?
anti-D Ig prophylaxis is only indicated following
- ectopic pregnancy
- molar pregnancy
- therapeutic termination of pregnancy
- in cases of uterine bleeding where this is repeated, heavy or associated with abdominal pain
The minimum dose should be 250 IU. A test for fetomaternal haemorrhage (FMH) is not required (Grade 2C).
What is the recommendation on the administration of Anti-D 12-20 Weeks gestation?
For potentially sensitising events between 12 and 20 weeks gestation, a minimum dose of 250 IU should be administered within 72 h of the event. A test for FMH is not required (Grade 2C)
What is the recommendation of Anti-D administration after 20 weeks gestation?
For potentially sensitising events after 20 weeks gestation, a minimum anti-D Ig dose of 500 IU should be administered within 72 h of the event. A test for FMH is required (Grade 2C).
When is routine anti-D prophylaxis administered?
28 + 34 weeks
(+ after delivery if then baby is tested and confirmed Rhesus D+ve)
What additional investigations should be done at booking if a woman discloses previous (but no current) IV drug use?
Hepatitis C bloods
What should be done if a woman discloses current drug use during pregnancy (pre-booking)
Midwive should gain consent for
* urine toxicology screen
+ consider referral to safeguarding team and drugs and alcohol services
When are periods expected to come back with
- bottle feeding
- mixed feeding
- exclusive breast feeding
- Bottle feeding: 5-6 weeks
- Mixed feeding: same
- exclusively breastfeed: potentially until no more night time feeds or weaning+ milk substitution begins
When can a woman who got methotrexate for ectopic pregnancy try to get pregnant again?
12 Weeks
What are some reasons for an echogenic bowel at 20 Week scan?
- Small bleed + swallowing of blood (benign)
- Cystic fibrosis (3% have CF if echogenic bowel seen)
3.CMV infection
What is the pharmacological management of nausea in Hyperemesis Gravidarum?
1st line:
i. H1 receptor antagonist (Cyclizine, meclozine, diphenhydramine (safe in pregnancy)
2nd line
i. Combination can be used if not responding to a single anti-emetic
3nd line:
i. Metaclopromide for 5 days, phenothiazines Increased risk of extrapyramidal side effect
ii. Ondansetron (slight increase of cleft palate, not very strong data)
If resistant: corticosteroids (but used as reserve)
What is the rehydration regime in hyperemesis gravidarum?
a. 1 bag pabrinex
b. 2 bags of saline with some potassium chloride (1L over 2h, 2nd Litre in next 2-4h)
+ LMWH as long as IV fluids needed
A 1 day old infant presenting with a rash - what is the most likely diagnosis?
Eythema toxicum
Common rash presentign in full-term newborns (within first week of life)
Usually small red macules and papules (can progress to pustules)
Self-limiting with 7-14 days
A woman presents with Reduced Fetal movements - what should be done?
All if pregnancy >28 weeks:
- Fetal Heart rate auscultation w hendheld doppler
- Asessment for FGR/ SGA (can be USS, can also be SFH)
- CTG
- If all normal but recurrent RFM: USS growth scan
5.
What should be the management of periorbital cellulatis in children?
Periorbital cellulitis should be treated promptly with IV antibiotics (e.g. high-dose ceftriaxone)
* MRSA will require vancomycin
* May give empirical antifungal therapy
- This is to prevent posterior spread of the infection which could cause orbital cellulitis
- Incision, drainage and culture of peri-ocular abscess may be required
- Consider ophthalmologist advice
What is the recommendation for mediation switching from fluoxetine to other antidepressants, including
* SSRI
* TCA
* SNRI
Generlly: Stop fluoxetine, start SSRI at a low dose 4–7 days later
What are the recommendations of mediaction switching of citalopram, escitalopram, sertraline, or paroxetine to a different antidepressant medication?
What are the most common electrolyte abnormalities in anorexia?
- Hypokalaemia
- Hyperlipidaemia (high triglycerides)
What is the management of 1+ asymptomatic proteinura during pregnancy?
Follow up in 1 week and repeat BP + urine dip
If still proteinuria: albumin: creatinine ratio
What is the management of new 2+ proteinuria but normotensive during pregnacy?
Same day obs asessment, regardless of associated symptoms of UTI presen t
What is the scoring system used in croup?`
Westley croup score
How long should people stay in hospital after a
1. vaginal hyterectomy?
2. abdominal hysterectomy?
- Vaginal: 1-4 days
- Abdominal: up to 5 days
When should someone after a histerectomy return to work?
f your job does not involve manual work or heavy lifting, it may be possible to return after 6 to 8 weeks. Your doctor will advise you when you can return to work.
Girl with dyskaryosis has colposcopy and biopsy showing CIN1. When should next colposcopy be?
1 year
How do you calculate EDD based on LMP?
LMP - 3 months, + 7 days (+1 year)
(+ days that the regular cycle was over 28 days)
What is the management for PID?
- Empirical abx (Ceftriaxone 1 g as a single intramuscular (IM) dose, followed by oral doxycycline 100 mg twice daily plus oral metronidazole 400 mg twice daily for 14 days)
- Analgesia
- STI screen (ideally before commencement of abx but should not delay abx)
- consider removal of IUS/IUD)
*
What are the age definitions for
1. POI?
2. early menopause
3. menopause
- POI <40
- early menopause 40-45
- menopause from 45 (average 51)
When should you do a Kleinhauer test?
For sensitising events >20 weeks
+
What is the management of vaginal candidiasis
1. without pregnancy
2. in pregnancy
- without pregnancy:Advise fluconazole 150 mg oral capsule as a single dose first-line.
2.Pregnancy: Prescribe clotrimazole pessary 500 mg intravaginally at night for up to 7 consecutive nights first-line (if aged 16 years and older).
what is the medical management for OCD?
SSRI first line
2nd line: clomipramine
(always with CBT and exposure CBT)
