Past Papers Flashcards by a b

Kid faltering growth, what could be the cause?

Coeliac

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Croup child
given Dex 12 hours ago but still has mild stridor
Next step?

Repeat steroids

Nebs Adr, Salbutamol, O2

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Kid anal itch Mx

Mebendazole cream

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Child impaired taste then awareness, then sleeps for 1 hr and no memory after. Dx?

Focal seizure

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Kid with yellow and grey stools and was like 4 weeks old or something. What do you test for?

Conjugated bilirubin levels

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Hypochloraemic hypokalaemic pH shown, with some clinical information. What is the initial management for it?

Correct electrolyte imbalance

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Question on a kid who had bloods that demonstrated: low platelets, normal white cells and normal red cells.

ITP

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Voraciously hungry kid, hypotonia and almond eyes.

Dx?

Prader-Willi

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neonate with reduced leg movements or something and his temperature was a bit high. What was it (?>38)?

Osteomyelitis

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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

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unwell child where chest was clear, had a fever. Lost weight recently. What do you do next?

ABC

Glucose

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Neonate
reduced leg movements
Temp 38

Osteomyelitis

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Child
rashes crusted over, but still scratching
now fever and cool peripheries

Varicella zoster viraemia

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Neonate

Systolic murmur on left sternal edge

VSD

or innocent? aSx, soft systolic, left sternal edge

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Child
55th centile
vomiting after food
bottle and breast fed

Cow’s milk protein allergy

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ADHD Mx

Parental training

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Mx conduct disorder

Multisystemic (family) therapy

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Child
Hip pain on exercise and climbing stairs
Prolonged history, otherwise well

Perthe’s

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2 y/o intermittent limp, otherwise well

DDH

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Uncle has TB
Child mantoux test 10mm
Next step?

Anti-TB Tx

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Gold standard for precocious puberty

Gonadotrophin stimulation test

<8 in F, <9 in M

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Child
Fussy eater
drinks lots of cows milk
tired
Cause?

Fe deficiency anaemia

due to fussy eating

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What area brain affected cerebral palsy

motor cortex

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Child with SCD
No reticulocytes
cause?

parvovirus

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single, acute hepatotoxic paracetamol dose (>150 mg/kg) has been ingested within the past hour

activated charcoal

paracetomal OD (>4g or 75mg/kg) 8hr since dose

IV acetylcysteine

Kid needs fluids, but you can’t get standard IV access, where do you go?

Intraosseus

Non-obese child | loss internal rotation of leg

SUFE

HIV mother undetectable viral load Contraindication in labour?

Foetal blood sampling

60 y/o PMB and superficial dyspareunia likely Dx?

Atrophic vaginitis

Woman having implant removed | likely reason?

irregular bleeding

Pre-eclampsia first line Mx

Labetolol

Intermittent pain | young woman cause

endometriosis

17 y/o emergency contraception | 5 days post UPSI

copper IUD

Contraception 6 days post birth

none needed | PROGESTERONE PILL

Intrauterine growth + endometrial thickness

Fibroids

painful periods first 2 days every since menarche

primary dysmenorrhoea

Breast abscess and mastitis whilst breastfeeding Mx

Ciprofloxacin

Carry on sertraline in pregnancy?

yes

Woman in labour 4hr check 4sm dilated. Next step

cervical sweep

PPH with with BP Mx

Syntocinon

Foreign woman pregnant. Which vaccine?

Hep B | whooping cough for all women

Heavy periods first line Mx

IUS if wants kids then tranexamic acid

Foetus transverse lie recent SROM CTG abnormal likely cause?

cord prolapse

last period 10 ago, has hot flushes | Mx?

cyclical (sequential) combined HRT

planned C-S DVT Mx

LMWH and TED STOCKINGS

Woman with blocked tubes, blocked tubes on hysterosalpingogram, what treatment should you do for fertility?

IVF

heavy periods not sexually active Mx?

tranexamic acid

elderly woman itching white patch

lichen sclerosus

How to measure Hep B at booking

HBsAg

Commonest cause azoopermia (low no)

varicocele

Woman on COCP, has missed 6th and 7th day pill, UPSI two days ago urine pregnancy is clear. What to do?

emergency contraception

Endometriosis, had laparoscopic adhesiolysis - high CRP, low Hb, constipation, bowel sounds absents etc - what’s happened?

intrabdo bleeding

FSH and LH in PCOS

FSH normal | LH N or high

Alcoholic has cellulitis, given chlordiazepoxide and Abx, what else do you give

Pabrinex

AD for depression with PMH of MI

Sertraline

Clozapine effect on WCC

neutropenia

Haloperidol, develops muscle problems

IM Procyclidine

Woman on venlafaxine, starts developing symptoms of mania | What do you do?

Stop venlafaxine

50 year old guy wanders in screaming he sees ants and tiny men running around

delirium tremens

Alcoholic wants to quit and wants something for reducing cravings

Acamprosate | Disulfiram, Naltrexone

AP that likely to cause tremor

Haloperidol

LBD given drug that makes it worse

Haloperidol

Guy writes letters to the PM, think he’s being spied on by the government for the past 10 years, shows no other symptoms

Delusional disorder

50y lady fell over gardening, comes in with paralysis of leg, no medical cause found?

Conversion disorder

Patient on ward becomes aggressive, verbal de-escalation hasn’t worked. Tx?

IM lorazepam

Husband brings in wife who has bipolar, who’s taken 20 “white” tablets - has a tremor and other sx. What tablet has she overdosed on?

lithium overdose

Lithium - what do you monitor?

Lithium, TFTs, U+E

Premature ovarian failure | Mx of menopausal Sx

combined HRT

Woman is pregnant and HIV negative at booking but her partner is HIV positive - what do you do?

Nothing

Define onset active labour

regular contractions os >4cm ROM

Subfertility azoospermia Mx

Intracytoplasmic Sperm Injection

Ovarian cyst ground glass appearance

Endometrioma

White discharge Dx Mx Candida (topical clotrimazole, clotrimazole pessary/fluconazole orally STAT, severe two doses oral, HIV/DM 7 days oral) – odourless, white curdy discharge ph<4.5 ; BV (metronidazole – 400mgBD for 7days, ok in pregnancy and breastfeeding) – white/grey, offensive fishy discharge, pH >4.5 and fishy smell on KOH to substance; Trichomoniasis (Metronidazole 400mgBD 7 days) – yellow-green discharge pH >4.5. Cervicitis/PID due to chlamydia/gonorrhoea (1g Azithromycin/IM Ceftriaxone + 1g Azithromycin) (inflamed cervix bleeds easily, mucous-like discharge.

Candida ``` Topical/pessary clotrimazole oral fluconazole (not if pregnant) ```

Child erythematous rash flexures satellite lesions Mx

Candidal dermatitis | topical imidazole + stop barrier cream

Offensive, thin, white/grey 'fishy' discharge clue cells/ stippled vaginal epithelial cells vaginal pH > 4.5 positive whiff test (addition of potassium hydroxide results in fishy odour)

Bacterial vaginosis Mx = Oral metronidazole

Offensive, yellow/green, frothy discharge Vulvovaginitis Strawberry cervix (erythematous cervix with pinpoint areas of exudation)

Trichomonas vaginalis Mx = Oral metronidazole

White discharge 'Cottage cheese' discharge Vulvitis Itch

Candida

3 months old baby with signs of HF, systolic murmur that radiates over the praecordium

VSD | pan-systolic murmur

``` 15 year old buy short stature urine 10 times a day, no dysuria Pale HR 78bpm BP 158/88 RR 14 What is the likely diagnosis? ```

Chronic renal failure

Infant with episodes of throwing arms forward with fists clenched

Infantile spasms present 4-8m, M>F poor prognsosi 'salaam' attacks: flexion of the head, trunk and arms followed by extension of the arms lasts 1-2 seconds, repeated up to 50 times progressive mental handicap EEG shows hypsarrhythmia in 2/3 CT - diffuse/localised brain disease in 70% (e.g. tuberous sclerosis) Management = poor prognosis vigabatrin + ACTH

``` 6 year old 24 hour history left peri-orbital swelling URTI last week Left proptosis, visual acuity normal fever of 38.9 Ix? ```

CT nasal orbits | Peri-orbital cellulitis unilateral, after URTI sinusitis, risk abscess and orbital cellulitis - vision loss

Child with fever of 39, high resp rate, nurse says chest is clear, what investigation do you do?

Urinalysis

Child with fever, white exudate on one tonsil

Quinsy

Baby is almost a month old and jaundiced. Parents say has been jaundiced since day 2. Stools are grey or white

Biliary atresia

recurrent abdominal pain associated with going to school. She is diagnosed with functional abdominal pain. What would your advice be with regards to her management?

GO to school, come home when pain starts

Woman who had FGM when she was 6 and is not pregnant and said she definitely won't do on her daughter - what do you do?

Police

14 year old primary amenorrhoea + ejection systolic murmur

Turners bicuspid aortic valve (15%) coarctation of the aorta (5-10%)

What is not a risk factor for primary PPH

B thalassaemia trait

Pregnant woman previous GDM what is the best way to investigation her blood glucose?

OGTT asap after booking and 24-28w If other risk factors, just do at 24-28/40 5.6 for fasting and 7.8 for 2 hours

GDM targets fasting 1 hr post meal 2 hr post meal

5. 3 fasting 7. 8 1 hr post 6. 4 2 hr post

APH definition | possible causes

>24 weeks, before labour placenta praevia abruption vasa praevia

contraception that increases risk of osteoporosis

Depot Provera

When to give Fe in pregnancy

Give Fe if <110 in early pregnancy <105 after 28wk <100 in postpartum

HRT for - perimenopausal - postmenopausal - no uterus

perimenopausal = cyclical combined HRT postmenopausal (no periods 12m) = continuous combined HRT no uterus = E2 only HRT

Mx of POF who wants to bleed POF = <40 y/o, no/irregular periods, raised FSH at least 4-6wk apart

cyclical oral HRT

Mx | Women with menopausal symptoms, hysterectomised, does not want to take oral tablets

transdermal oestrogen HRT

Women with menopausal symptoms and has eczema Mx

oral combined HRT

Clue cells b. – c. – d. Lichen sclerosis e. Curdy white-yellow discharge – candidiasis f. Blue dots on cervix

Bacterial vaginosis

Strawberry cervix

Trichomonas

Painful multiple lesions on labia

herpes

itch and white plaques on vulva

lichen sclerosus

likely diagnosis | smear comes back as moderate dyskaroysis

CIN2

76 year old had a single brown discharge

endometrial cancer

Intermittent pain + vomiting likely Dx

ovarian torsion

Mother with stillborn baby, generalized oedematous when born, mother had fever at 18w with rash on trunk

parvovirus

Women going away for holiday and would like to delay her periods.

Continuous COCP or | Norethisteron

32 yo has 2 children done with family, had COCP before Mx

Mirena

47yo women with menorrhagia + dysmenorrhea, US showed multiple fibroids

Hysterectomy

Mother being prepared for CS, sudden tingling around her mouth?

Spinal block

Mother being prepared for CS and has a regional block, sudden tachycardia, SOB, difficulty in breathing

Anaphylaxis

Mother with girl who doesn’t speak | Mx

refer for hearing assessment

Dehydration + ill kid – weight 15kg what do you give initially?

300ml bolus IV - remember bolus in DKA is 10ml/kg and only if they’re in shock

Rash not involving flexures Mx

Zinc barrier cream | irritant dermatitis

Scabies

permethrin 5% is first-line, malathion 0.5% is second-line

napkin rash satellite lesion flexures

candida

sit without support referral

normal 7-8m REFER at 12m

walking referral

18m

Hops on one leg

normally by 4y, refer by 5y

normal pincer

pincer by 10m | refer at 12m

normal smile | refer at

normal - by 6wk | refer at 8wk

Neonate getting progressively worse at breathing over first 3h with opacities

GBS

Neonate Still needs oxygen

Bronchopulmonary dysplasia

Neonate CXR groundglass appearance

RDS

abdo mass associated with haematuria (pyrexia may occur in 50%)

nephroblastoma/Wilm's

18m absence of red-reflex, replaced by a white pupil (leukocoria) strabismus visual problems

retinoblastoma Management = enucleation depending on how advanced the tumour is other options include external beam radiation therapy, chemotherapy and photocoagulation good prognosis

sore throat, cervical lymphademopathy, been given antibiotics, rash comes on Virus?

EBV

Child | Intermittent pain, dehydrated, vomited 3 times

Intususseption

Sudden abdo pain, well child, something indentable on the L lower quadrant

Wilm's

just started on an antipsychotic and becomes tachycardia, hyperthermia, sweating, urine drug screen negative

NMS

bulimia, BMI 22, well and keen to get treatment

Fluoxetine + CBT

Section 4

72 hour assessment order used as an emergency, when a section 2 would involve an unacceptable delay a GP and an AMHP or NR often changed to a section 2 upon arrival at hospital section 5(2) is 72hr for someone already in hospital

lost her husband 7 months ago and started hearing voices of him saying to join him a month ago

abnormal grief response

78yo guy has issues with organization, troubles with understanding words

frontal temporal dementia

One of the criteria for learning disability?

IQ <70 Mild >50, Moderate >35, Severe >20, Profound >20

Who would you refer a schizophrenic patient to if they are being discharged and needs support in the community regarding treatment?

Community psychiatric nurse

Something that works on 5HT receptors?

MDMA (also LSD)

Lady has a diagnostic laparotomy. She has suprapubic pain that not even IV paracetamol is helping. What is the likely reason?

Urinary retention

Child is an arsonist. Gets in fights. Attacks teachers. What is he likely to have at age 20?

Dissocial/antisocial personality disorder (also high risk in ADHD) Conduct disorder >10 Oppositional defiant disorder <10

Ortalani positive neonate | Mx?

USS Hip 6wk

What defines a mild learning disability?

<70

Lady with social phobia. What feature would typically be associated with it?

people noticing you blush

Two fetal poles, one gestational sac

Monoamniotic

Most likely effect from cheese reaction due to MAO-I

Hypertension

Common S/E of clozapine

hypersalivation

Commonest type of endometrial cancer?

Type 1 AKA endometrioid

Walking

15 months  

2-3 word sentences

2 years old

28 day child with pale stools

Biliary atresia | will also have prolonged jaundice, high conj bilirubin

Child falls. Parents pick him but has a tonic-clonic seizure. Is complete well afterwards

Reflex Anoxic   (pale) )Breath holding attacks = baby blue +/- LOC)

Gardisil protects against

HPV 6, 11, 16, 18 16 + 18 -> cervical cancer

UTI Tx in pregnancy

Nitro or Cefalexin | CANNOT take trimethoprim

Cystic ovaries on scan, best other indicator for PCOS?

Hirsutism

PCOS drug to increase fertility

Clomifene | metformin = 2nd line/adjunct

Marker of POF

Raised FSH | also high LH and low AMH

Mx POF

continuous combined HRT (if 1yr amenorrhoea) cyclical if <1yr amenorrhoea (as risk endometrial hyperplasia with continuous) also: testosterone contraception bisphosphonates

ASx nulliparous woman 5.4cm unilocular cyst USS no Fhx Mx?

USS 3m f/u and Ca125 NB: Postmenopausal + cyst= TVUSS + Ca125 If RMI>200 = CT/MRI + MDT RMI <200+ ASx/<5cm/unilocular unilateral = 4m TVUSS + Ca125 RMI<200 + abnormal features = salpingo-oophorectomy

8 weeks post SVD + 2nd degree tear bleed and mild lower abdo pain Dx?

endometritis

Cause of increased urine volume + frequency in 1st trimester

Increased GFR

paroxetine risk in pregnancy

congenital malformations

Effects of fluoxetine in pregnancy on baby

PPHN NB avoid fluoxetine in breastfeeding as long 1/2 life. Use paroxetine or other SSRI

Nexplanon common side effect

irregular bleeding

Small painful lump inside vagina of sexually active woman

Bartholin's

Acne | Next step Mx after topical steroids

Retinoids | nb. isoretinoin/roaccutane in 2 care as teratogenic

Child pain outer ear, lump behind ear

mastoiditis

contraIx to 4m vaccine

fever >38.5

Suicide risk. What is the highest predictor of doing it again?

feeling hopeless about future | >previous self harm

80 year old man with new onset dementia, needs MRI but refuses. You need someone to make decision for him

ask independent mental health advocate

``` Acute onset Sx hyperreflexia myoclonus (rapid jerky) ocular clonus mydriasis/dilated pupils normal bloods ```

Serotonin syndrome stop ADs IV fluid + BDZ Cytoheptadine and Chlorpomazine in severe cases

rigidity decreased reflexes increase CK, WCC, low Fe over 1-2 weeks

NMS

Management of NMS

stop AP IV fluids + BDZ DANTROLENE (if severe) and bromocriptine

Mild/moderate/severe/profound LD

LD IQ <70 ``` mild = 50-60 moderate = 35-49 severe = 20-34 profound = <20 ```

Treatment resistant schizophrenia on clozapine, recently stopped smoking. High level of clozapine now. Most likely consequence?

Seizures | agranulocytosis is NOT dose-dependent

Dx biliary atresia

USS and liver biopsy

``` normal neonatal birth wt faltering growth prolonged jaundice high conj bili dark urine pale stool ```

Biliary atresia USS and liver biopsy and ERCP Mx = Kasai

small slow-growing lesion | pregnant

HPV warts

Lady with a viable intrauterine pregnancy. LIF pain –initially episodic, now continuous

ovarian torsion

Sitting unsupported

Walking

15 months  

2-3 word sentences

2 years

Pincer Grip

10 months  

28 day child with pale stool and jaundice

biliary atresia

Child falls. Parents pick him but has a tonic-clonic seizure. Is complete well afterwards

Reflex Anoxic  

Woman with a slow growing painless lesion on labia

Bartholins

Woman with tender lump inside her vagina, sexually active

HPV warts HPV 6+11 - warts HSV = lips cold sores or genital herpes, distinct from warts and have a papulovesicular morphology - multiple painful lesions on labia

Kid with history of anal fissure - what is your first cause of action?

inspect anal region

5 month old with cough, runny nose, fever, wheeze. | pathogen?

RSV

Woman wants to know what risk her baby has of getting schizophrenia, since the baby’s father has it.

12-15%