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Past papers specialites Flashcards

1
Q

What is management of functional pain with regards to school

A

Make them go regardless

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2
Q

Physical sign of social phobia

A

Facial blushing

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3
Q

Varicella encephalitis presentation

A

Cerebellar symptoms

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4
Q

What causes increased urinary volume and frequency in the first trimester

A

Increased GFR due to progesterone

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5
Q

A level student has recently come back from nigeria, with symptoms of jaundice, mild anaemia and fever with malaise,arthralgia.

A

Hep A

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6
Q

Risk of first relative getting schizophrenia

A

1/10

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7
Q

If stop smoking on clozapine, what consequence is likely to happen

A

Seizures as this is dose dependant

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8
Q

Management of SAD-Q scores

A

Mild=0-15- CBT and oral thiamine
Moderate= 16-30 Refer to local alcohol service
Severe= 31+ Refer for inpatient

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9
Q

Who admit to hospital for alcohol withdrawal

A

At high risk of delirium tremens
Poor social care
Under 17
Got other severe mental or physical illness

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10
Q

Alcoholic comes to GP requesting home detoxification. Previous history of delirium tremens. What would you do?

A

Refer to hospital for controlled withdrawal

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11
Q

What is it when things appear small

A

Micropsia

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12
Q

Which ovarian cyst has a groundglass appearance

A

Endometrioma

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13
Q

What is the most important thing to look at in follow up of HSP?

A

Urine protein

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14
Q

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

A

VSD

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15
Q

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?

A

CKD

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16
Q

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?

A

CT of nasal orbits

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17
Q

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

A

Intra-osseous

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18
Q

Child with precocious puberty- what is first investigation

A

Gonadotorphin stimulation test

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19
Q

What procedure is contra-indicated in HIV pregnant woman?

A

Foetal blood sampling

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20
Q

If in hospital how give thiamine

A

IV pabrinex

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21
Q

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?

A

Low dose benzo

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22
Q

First line for conduct disorder

A

Family therapy

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23
Q

Rash on child with red bumps and white spots

A

Roseola

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24
Q

Why is a fussy eater pale and tired

A

IDA

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25
Q

If woman comes in query manic what test do

A

TFTs

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26
Q

Loss of libido. DHx COCP Cetirizine Salbutamol inhaler. What is the cause of loss of libido?

A

COCP

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27
Q

Kid with semi circular bruises on his thigh

A

NAI

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28
Q

On newborn check, inverted ankles and plantar flexed, what sign is this

A

Talipes equinovarus

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29
Q

Maternal T1DM increases risk of what conditions in newborn?

A

Neural tube defect
RDS
Hypoglycaemia
Transposition of great arteries

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30
Q

EBV investigations

A

Under 12
- in second week of illness do serology
Over 12
- in second week do monospot and FBC with differentiated WCC

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31
Q

Management of undescended testicles

A

Bilateral
- at birth get endo review with 24 hours
- if at 6-8 weeks see specialist within 2 weeks
Unilateral
- at birth review in 8 weeks
- if at weeks seen review at 4-5 months
- if still positive here refer to surgeons

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32
Q

On antipsychotic and start sweating profusely

A

Akathisia

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33
Q

Lady with ectopic wants to know how long after methotrexate tx you can/should wait to get pregnant

A

3 months
6 months if more than 1 dose

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34
Q

Preg woman w history of cocaine and cannabis use, hasn’t done drugs for the -last 3 years, what would midwife do in addition to booking bloods?

A

Hep C antibodies offered

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35
Q

Woman with severe pain due to fibroids in pregnancy. Opiate does not help. 32 weeks pregnant. Management?

A

Epidural

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36
Q

If woman with NVP fails to respond to first line anti-emetic what do

A

Switch class
If this fails then refer to specialist help

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37
Q

When can women with NVP be treated in ambulatory

A

Failed to respond to primary care and PUQE under 13

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38
Q

Woman with 1+ protein on urine dipstick but normal blood pressure at 32 weeks. Mx?

A

Repeat in 1 week

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39
Q

What do if persistent +1 on urine dip in pregnancy

A

ACR

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40
Q

When is post coital bleeding referred routinely to general gynae clinic (18 week pathway)

A

Persistent PCB, 6 weeks and negative STI/Chlamydia
Persistent PCB, 12 weeks after treatment of STI/Chlamydia

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41
Q

When take a smear alongside swabs for PCB

A

If smear overdue

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42
Q

What do if neither MANTRA. SSCM or CBT work for AN

A

Focal psychodynamic therapy

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43
Q

Probability of being permanently paralysed from epidural

A

1 in 250,000

44
Q

What is it when do not feel like you are real

A

Depersonalisation

45
Q

What do if 2+ protein in pregnant womans urine without HTN

A

Refer for urgent assessment

46
Q

What blood sample use for checking varicella antibodies

A

Can use booking bloods

47
Q

What is used to prevent PTSD

A

Debriefing

48
Q

What do if develop migraine without aura on COCP

A

UKMEC 3

49
Q

How long do assisted withdrawals from alcohol last

A

In community- 7-10 days
Inpatient- 2-3 weeks

50
Q

How long do assisted alcohol withdrawals last

A

In community- 7-10 days
Inpatient- 2-3 weeks

51
Q

Once withdrawn from alcohol, what is management

A

Conduct full medical ssessment looking at LTFs and U&Es
Start on naltrexone or acamprosate with a psychological intervention
If got a willing partner do behavioural couples therapy
If not any CBT or behavioural therapy

52
Q

If mild alcohol dependance what do

A

Oral thiamine
Plus a psychological intervention
- if a good partner then behaveioural couples therapy
- if not then CBT, behavioural therapies or social network and environment-based therapies

53
Q

Stepped care for panic disorder

A

Mild to moderate then offer individual facilitated or non facilitatedself help
Moderate to severe- CBT or antidepressant if conditon longstanding
SSRI for 12 weeks- no success change to clomipramine or venlafaxine
If no improvement after 2 interventions then refer to specialist

54
Q

Managing discontinuation from SSRIs

A

If mild- monitor
If severe- restart at previous dose and slowly reduce

55
Q

What does sliding sign suggest

A

Ectopic pregnancy

56
Q

What causes severe ankle pain in sporty 11 year old

A

Severs disease

57
Q

What is central precocious

A

When features of puberty develop earlier than would expect with normal biochemical findings of puberty
<8 in girls
<9 in boys

58
Q

Periorbital cellulitis

A

Refer to hospital no matter what
Mild
- oral co-amoxiclav
Severe (any severe feature- fever over 38, proptosis, eye movement affected)
IV ceftriaxone

59
Q

Almond eyes and narrow forehead

A

Prader willi

60
Q

How manage delayed first stage of labour due when membranes are intact

A

Amniotomy

61
Q

When repeat smear for excised CIN 1

A

6 months

62
Q

What can be presentation of somatisation

A

SOB
Abdo pain and nausea
Vomiting
Headache

63
Q

If woman goes into preterm labour, what is important part of where admitted

A

Has a neonatal unit which can manage preterm babies

64
Q

Why is a barium enema done in hirschprung

A

Will help differentiate it from other causes as well as treat
In hirschprung there will be dilated and constricted part (dilated where aganglionic)

65
Q

When are vaginal examinations contraindicated

A

Preterm ROM
HSV infection
Antenatal haemorrhage

66
Q

Can you do a digitial examination in ROM

A

Not in preterm ROM
Not in SROM if no contractions
Can once labour has started to fel for prolapse

67
Q

Management of pierrre robin sequence

A

If struggling to feed then initially try advanced feeding techniques
If no success surgery

68
Q

What is semantic dementia

A

When can not give names to specific objects
Presents in younger age range

69
Q

What is management of central apnoea

A

Physical stimulation first line
Second line artificial breaths withbag valve

70
Q

What can incontinence be in psot menopausal woman

A

Atrophic vaginitis!

71
Q

What congenital infection can lead to congenital hydrocephalus

A

Rubella

72
Q

If woman refuses outpatient hysteroscopy for menorrhgia what offer instead

A

Hysteroscopy under GA
If refuses this do TVUSS

73
Q

Side effect of entonox

A

Nausea and lightheaded

74
Q

If give any opioid analgesia what must give alongside

A

Anti-emetic

75
Q

What must be done with regards to postnatal care if ROM for over 24 hours

A

Stay in hospital at least 12 hours
Make sure gives birth at centre with neonatal services

76
Q

Management of oxytocin infusion in first stage of labour

A

Re-examine in 4 hours
- if less than 2cm advanced obstetric review
- over 2cm advise 4 hourly vaginal examinations

77
Q

Definition of delayed second stage of labour in nullip vs multip

A

2 hours in nullip and then move to operative vaginal birth
1 hour in multip and move to operative vaginal birth

78
Q

When can perform an episiotomy according to NICE

A

Instrumental birth needed
Suspected foetal compromise

79
Q

What do if significant meconeum present in the labour

A

Ensure HCP who are trained in advanced neonatal life support are readily available for the birth
Transfer to obstetric led care

80
Q

Pain management in advancedlabour

A

Entonox first
Second- diamorphine
Third- pethidine

81
Q

Best test for pertussis

A

PCR

82
Q

What is first line insulin method used in GDM

A

Single injection in morning
Second line= short acting before every meal

83
Q

Management of ODD or conduct disorder guidelines

A

Aged 3-11- parent training programmes
Aged 9-14- child focused programmes (group social cognitive solving problems)
Aged 11-17- multimodal interventions like multisystemic

84
Q

Who offer treatment for ODD or conduct disorder

A

At risk of developing them
Have the condition
In contact with criminal justice system due to antisocial behaviour

85
Q

What is a morbiliform eruption

A

Name given to drug reaction in EBV and amoxicillin

86
Q

What do in sepsis first

A

Abx unless another A-E needed

87
Q

Bulimia management

A

Self help
If not then ED-CBT

88
Q

Clozapine toxicity presentation

A

Tachycardia
Ataxia
Confusion

89
Q

Antibiotics for severe PID

A

IV ceftriaxone
Oral doxycyline
Oral metronidazole

90
Q

Preicipitants of transient proteinuria

A

Seizures
Infections
Severe exercise

91
Q

What can be used to collect urine sample in an infant

A

Urine collection pad

92
Q

What infection presents with bright red cracked lips and peri-oral sparing

A

Scarlet fever

93
Q

Main side effect of memantine

A

Constipation
Is diarrhoea in acetylcholinesterase inhibitors

94
Q

What is presentation of juvenile dermatomyositis

A

Fatigue
Joint pain
Weakness of proximal muscles
Malar rash
Heliotrope rash over eyelids

95
Q

What are U waves seen in

A

Hypophosphataemia after refeeding

96
Q

What are the 2 hands techniques for labour

A

Hands on- guarding perineum and flexing babies head
Hnads poised- hands off in preparation
Both done to reduce risk of perineal trauma

97
Q

What do if woman declines tested anaesthesia for instrumental

A

Pudendal nerve block offered

98
Q

When consider instrumental according to NICE

A

Concern about wellbeing
Prolonged second stage

99
Q

Difference between doing episiotomy and instrumental

A

Think about where babies head is
If by perineum do episiotomy

100
Q

What does passive management of third stage involve

A

no routine use of uterotonic drugs
no clamping of the cord until pulsation has stopped
delivery of the placenta by maternal effort

101
Q

What defines prolonged third stage

A

30 minutes if active
60 minutes is passive

102
Q

When clamp chord in active management

A

Between 1 and 5 minutes

103
Q

What does controlled chord traction involve

A

Suprapubic pressure
Pulling chord once signs of separation

104
Q

What do if in passive third stage if there is haemorrhage or delayed beyond 1 hour

A

Advise change to active

105
Q

Management of retained placenta

A

Secure IV access
Give IV oxytocin if bleeding
Examination to determine if need manual removal
Before manual removal or uterine exploration need anaesthetic

Last minute (11 decks)

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