Past papers specialites Flashcards
What is management of functional pain with regards to school
Make them go regardless
Physical sign of social phobia
Facial blushing
Varicella encephalitis presentation
Cerebellar symptoms
What causes increased urinary volume and frequency in the first trimester
Increased GFR due to progesterone
A level student has recently come back from nigeria, with symptoms of jaundice, mild anaemia and fever with malaise,arthralgia.
Hep A
Risk of first relative getting schizophrenia
1/10
If stop smoking on clozapine, what consequence is likely to happen
Seizures as this is dose dependant
Management of SAD-Q scores
Mild=0-15- CBT and oral thiamine
Moderate= 16-30 Refer to local alcohol service
Severe= 31+ Refer for inpatient
Who admit to hospital for alcohol withdrawal
At high risk of delirium tremens
Poor social care
Under 17
Got other severe mental or physical illness
Alcoholic comes to GP requesting home detoxification. Previous history of delirium tremens. What would you do?
Refer to hospital for controlled withdrawal
What is it when things appear small
Micropsia
Which ovarian cyst has a groundglass appearance
Endometrioma
What is the most important thing to look at in follow up of HSP?
Urine protein
3 months old baby with signs of HF, systolic murmur that radiates over the praecordium
VSD
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?
CKD
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
Kid needs fluids, but you can’t get standard IV access. Where do you go?
Intra-osseous
Child with precocious puberty- what is first investigation
Gonadotorphin stimulation test
What procedure is contra-indicated in HIV pregnant woman?
Foetal blood sampling
If in hospital how give thiamine
IV pabrinex
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?
Low dose benzo
First line for conduct disorder
Family therapy
Rash on child with red bumps and white spots
Roseola
Why is a fussy eater pale and tired
IDA
If woman comes in query manic what test do
TFTs
Loss of libido. DHx COCP Cetirizine Salbutamol inhaler. What is the cause of loss of libido?
COCP
Kid with semi circular bruises on his thigh
NAI
On newborn check, inverted ankles and plantar flexed, what sign is this
Talipes equinovarus
Maternal T1DM increases risk of what conditions in newborn?
Neural tube defect
RDS
Hypoglycaemia
Transposition of great arteries
EBV investigations
Under 12
- in second week of illness do serology
Over 12
- in second week do monospot and FBC with differentiated WCC
Management of undescended testicles
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
On antipsychotic and start sweating profusely
Akathisia
Lady with ectopic wants to know how long after methotrexate tx you can/should wait to get pregnant
3 months
6 months if more than 1 dose
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?
Hep C antibodies offered
Woman with severe pain due to fibroids in pregnancy. Opiate does not help. 32 weeks pregnant. Management?
Epidural
If woman with NVP fails to respond to first line anti-emetic what do
Switch class
If this fails then refer to specialist help
When can women with NVP be treated in ambulatory
Failed to respond to primary care and PUQE under 13
Woman with 1+ protein on urine dipstick but normal blood pressure at 32 weeks. Mx?
Repeat in 1 week
What do if persistent +1 on urine dip in pregnancy
ACR
When is post coital bleeding referred routinely to general gynae clinic (18 week pathway)
Persistent PCB, 6 weeks and negative STI/Chlamydia
Persistent PCB, 12 weeks after treatment of STI/Chlamydia
When take a smear alongside swabs for PCB
If smear overdue
What do if neither MANTRA. SSCM or CBT work for AN
Focal psychodynamic therapy
Probability of being permanently paralysed from epidural
1 in 250,000
What is it when do not feel like you are real
Depersonalisation
What do if 2+ protein in pregnant womans urine without HTN
Refer for urgent assessment
What blood sample use for checking varicella antibodies
Can use booking bloods
What is used to prevent PTSD
Debriefing
What do if develop migraine without aura on COCP
UKMEC 3
How long do assisted withdrawals from alcohol last
In community- 7-10 days
Inpatient- 2-3 weeks
How long do assisted alcohol withdrawals last
In community- 7-10 days
Inpatient- 2-3 weeks
Once withdrawn from alcohol, what is management
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
If mild alcohol dependance what do
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
Stepped care for panic disorder
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
Managing discontinuation from SSRIs
If mild- monitor
If severe- restart at previous dose and slowly reduce
What does sliding sign suggest
Ectopic pregnancy
What causes severe ankle pain in sporty 11 year old
Severs disease
What is central precocious
When features of puberty develop earlier than would expect with normal biochemical findings of puberty
<8 in girls
<9 in boys
Periorbital cellulitis
Refer to hospital no matter what
Mild
- oral co-amoxiclav
Severe (any severe feature- fever over 38, proptosis, eye movement affected)
IV ceftriaxone
Almond eyes and narrow forehead
Prader willi
How manage delayed first stage of labour due when membranes are intact
Amniotomy
When repeat smear for excised CIN 1
6 months
What can be presentation of somatisation
SOB
Abdo pain and nausea
Vomiting
Headache
If woman goes into preterm labour, what is important part of where admitted
Has a neonatal unit which can manage preterm babies
Why is a barium enema done in hirschprung
Will help differentiate it from other causes as well as treat
In hirschprung there will be dilated and constricted part (dilated where aganglionic)
When are vaginal examinations contraindicated
Preterm ROM
HSV infection
Antenatal haemorrhage
Can you do a digitial examination in ROM
Not in preterm ROM
Not in SROM if no contractions
Can once labour has started to fel for prolapse
Management of pierrre robin sequence
If struggling to feed then initially try advanced feeding techniques
If no success surgery
What is semantic dementia
When can not give names to specific objects
Presents in younger age range
What is management of central apnoea
Physical stimulation first line
Second line artificial breaths withbag valve
What can incontinence be in psot menopausal woman
Atrophic vaginitis!
What congenital infection can lead to congenital hydrocephalus
Rubella
If woman refuses outpatient hysteroscopy for menorrhgia what offer instead
Hysteroscopy under GA
If refuses this do TVUSS
Side effect of entonox
Nausea and lightheaded
If give any opioid analgesia what must give alongside
Anti-emetic
What must be done with regards to postnatal care if ROM for over 24 hours
Stay in hospital at least 12 hours
Make sure gives birth at centre with neonatal services
Management of oxytocin infusion in first stage of labour
Re-examine in 4 hours
- if less than 2cm advanced obstetric review
- over 2cm advise 4 hourly vaginal examinations
Definition of delayed second stage of labour in nullip vs multip
2 hours in nullip and then move to operative vaginal birth
1 hour in multip and move to operative vaginal birth
When can perform an episiotomy according to NICE
Instrumental birth needed
Suspected foetal compromise
What do if significant meconeum present in the labour
Ensure HCP who are trained in advanced neonatal life support are readily available for the birth
Transfer to obstetric led care
Pain management in advancedlabour
Entonox first
Second- diamorphine
Third- pethidine
Best test for pertussis
PCR
What is first line insulin method used in GDM
Single injection in morning
Second line= short acting before every meal
Management of ODD or conduct disorder guidelines
Aged 3-11- parent training programmes
Aged 9-14- child focused programmes (group social cognitive solving problems)
Aged 11-17- multimodal interventions like multisystemic
Who offer treatment for ODD or conduct disorder
At risk of developing them
Have the condition
In contact with criminal justice system due to antisocial behaviour
What is a morbiliform eruption
Name given to drug reaction in EBV and amoxicillin
What do in sepsis first
Abx unless another A-E needed
Bulimia management
Self help
If not then ED-CBT
Clozapine toxicity presentation
Tachycardia
Ataxia
Confusion
Antibiotics for severe PID
IV ceftriaxone
Oral doxycyline
Oral metronidazole
Preicipitants of transient proteinuria
Seizures
Infections
Severe exercise
What can be used to collect urine sample in an infant
Urine collection pad
What infection presents with bright red cracked lips and peri-oral sparing
Scarlet fever
Main side effect of memantine
Constipation
Is diarrhoea in acetylcholinesterase inhibitors
What is presentation of juvenile dermatomyositis
Fatigue
Joint pain
Weakness of proximal muscles
Malar rash
Heliotrope rash over eyelids
What are U waves seen in
Hypophosphataemia after refeeding
What are the 2 hands techniques for labour
Hands on- guarding perineum and flexing babies head
Hnads poised- hands off in preparation
Both done to reduce risk of perineal trauma
What do if woman declines tested anaesthesia for instrumental
Pudendal nerve block offered
When consider instrumental according to NICE
Concern about wellbeing
Prolonged second stage
Difference between doing episiotomy and instrumental
Think about where babies head is
If by perineum do episiotomy
What does passive management of third stage involve
no routine use of uterotonic drugs
no clamping of the cord until pulsation has stopped
delivery of the placenta by maternal effort
What defines prolonged third stage
30 minutes if active
60 minutes is passive
When clamp chord in active management
Between 1 and 5 minutes
What does controlled chord traction involve
Suprapubic pressure
Pulling chord once signs of separation
What do if in passive third stage if there is haemorrhage or delayed beyond 1 hour
Advise change to active
Management of retained placenta
Secure IV access
Give IV oxytocin if bleeding
Examination to determine if need manual removal
Before manual removal or uterine exploration need anaesthetic
