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PPQs Flashcards

1
Q

Total abdo Hysterectomy yesterday. Woman goes upstairs and faints. Normal BP. DX

A

Hypovolaemic shock

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2
Q

Gravidity and Parity Q - currently pregnant woman with hx of 1 x 37 week stillbirth, 1 x current 7 week pregnancy, 1 x premature baby, 1 x miscarriage

A

G4 P2+1

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3
Q

Lady who had a tear after delivering baby, a few days later has offensive discharge, no fever or other symptoms (last VSA of paper)

A

Infection of perineal wound

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4
Q

Girl with dyskaryosis has colposcopy and biopsy showing CIN1. When should next colposcopy be? 2 weeks?, 1 month?

A

12 months

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5
Q

30 yr woman with last menstrual period on 25th August, 31 days cycles. What is the EDD

A

June 4

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6
Q

Woman wants to terminate her 8 week pregnancy because she already has 3 children - which clause of the abortion act does this fall under?

A

D

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7
Q

45F. Wertheim’s hysterectomy. Last cervical smear 2 years ago. When next smear? 1 year?, no smears needed

A

no smears

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8
Q

Hysterectomy yesterday. How long to stay off work for: 48h/1w/4w/3 months

A

4 weeks

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9
Q
  1. Woman has come for a sterilisation, has had protected sex (definitely protected) since her last menstruation one week ago, just post-ovulation - immediate tx? Insert IUD, Cancel surgery, Continue with Surgery..
A

continue

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10
Q
  1. Which test for Down syndrome screening at 15 weeks? Amniocentesis, NIPT (think its this as this was the only SCREEN), CVS
A

NIPT

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11
Q

Woman had a 3B tear previously, what mode of delivery for current pregnancy?

A

Vaginal

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12
Q
  1. Girl has kid but has large tear a few years ago and is worried about this pregnant. What do you do different in this pregnancy? Prophylactic episiotomy. Elective C-section, episiotomy on the day
A

episiotomy on day

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13
Q

Woman gets headache 24hrs after delivery?? Post-dural headache, pre-eclampsia, migraines, cerebral vein thrombosis

A

migraine

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14
Q

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

A

cetirizine

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15
Q

Test to do in woman who is scantily dressed, irritated,

A

TFTs

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16
Q

Dad walked out asking about schizophrenia. Teenager daughter then asks at end of consultation whats the likelihood of schizophrenia herself - answer: arrange future consultation to discuss with her?

A

10%

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17
Q

Paramedic sees a patient die 1 month ago. He is sad and can’t sleep. What Dx? PTSD or acute stress reaction, depression, adjustment disorder

A

depression

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18
Q

Girl witnesses car crash and goes few hours later blind. Dissociative disorder? Acute stress reaction? Conversion disorder

A

acute stress reaction

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19
Q

Guy prescribed citalopram, name one possible side effect he should be told about?

A

low libido

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20
Q

Woman with dementia, which part of brain is likely to be affected early?

A

Hippocampus

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21
Q

Woman believes celebrity is her lover and writers letters to him. Then stalks him

A

Eratomania

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22
Q

Man with hyper-reflexia and tremor, what drug

A

Lithium

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23
Q

3 year old girl with tiredness and snoring, and frequent coughs and colds, and speech was normal but difficulty articulating words. What Ix

A

hearing test, karyotyping for downs?

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24
Q

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

A

talipes equinovarus

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25
Q

5 year old kid with headache and bed wetting, low end of normal specific gravity

A

cranial DI

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26
Q

You are in GP, Child with croup comes in? Keep child calm and send to A&E, Other option was GP give oral dex and review in 48hrs

A

GP give oral dex and review

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27
Q

How should you give influenza vaccine to kid who is allergic to eggs, cow’s milk protein….? in hospital IM injection, in GP, etc..

A

GP

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28
Q

4hr old new born baby has raised respiratory rate, everything else is normal

A

TTN

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29
Q

Maternal T1DM increases risk of what condition in newborn? Neural tube defects, hydronephrosis, gastrochisis, omphalocele, congenital diaphragmatic hernia

A

neural tube defects

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30
Q

Maintenance fluid to give to kid with diabetes mellitus - 0.9% saline, 0.9% saline with 5% dextrose, 0.9% saline with 4% dextrose

A

0.9% saline

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31
Q
  1. Pregnant woman has scan which shows anencephaly, until when can she have a TOP? Any point during this pregnancy, 24 weeks, 28 weeks, she can’t have one
A

anytime

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32
Q
  1. Kid from Pakistan whose parents are first cousins has acute respiratory failure and pneumocystis pneumonia, what dx? SCID, agammaglobulinemia, HIV, cystic fibrosis
A

SCID

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33
Q
  1. Neonate with fever, sunken fontanelle and reduced right leg movement, most likely dx? Osteomyelitis, NAI, sepsis
A

osteomyelitis

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34
Q
  1. Bilateral undescended testes in a phenotypically male newborn examination, most likely dx? Klinefelter’s, retractile testes, androgen insensitivity syndrome, increased oestrogen exposure in utero, physiological delay
A

physiological delay

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35
Q
  1. 14-year old girl presented to GP with short stature and no secondary sexual characteristics. Otherwise well. The mean parental height is on the 50th centile. What is most likely dx? Constitutional delay, Turner’s syndrome
A

turner’s

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36
Q
  1. Raised conj bili in a 3w old kid, what would you do next? Phototherapy, outpatient USS, inpatient USS
A

inpatient USS

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37
Q
  1. Kid falling to the ground with stiffening and tightening of hands, and screaming. Otherwise normal development. Dx? (repeat) Tonic clonic seizures, Temper tantrums, Reflex anoxic seizure
A

temper tantrums

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38
Q
  1. Between 5-10 year old with abdominal pain, loose stools and soiling. Passed a hard blood-streaked stool recently. Ix? (repeat) None at this stage, colonoscopy, anti-ttg, abdominal x-ray
A

none

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39
Q
  1. 3 year old girl well-kempt, who has reached developmental milestones, nursery comments that she does not speak much, her mother says at home she is well-behaved and plays alone quietly. Most likely diagnosis? Environmental understimulation, neglect, Alport syndrome, selective mutism, Autism
A

autism

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40
Q
  1. Child with bruises all over knees after being able to walk, some swelling in knee joint. Dx?
A

Haemophilia

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41
Q
  1. Adolescent with 6m or so of depression symptoms, what’s the next step in management? CBT, family therapy, sertraline, fluoxetine
A

CBT

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42
Q
  1. Man with OCD, CBT and SSRI aren’t working, what would you do next? Clomipramine
A
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43
Q
  1. Man with OCD, CBT and SSRI aren’t working, what would you do next? Clomipramine
A
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44
Q
  1. Man with OCD, CBT and SSRI aren’t working, what would you do next? Clomipramine
A
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44
Q
  1. Man with OCD, CBT and SSRI aren’t working, what would you do next? Clomipramine
A
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44
Q
  1. Man with OCD, CBT and SSRI aren’t working, what would you do next? Clomipramine
A
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45
Q
  1. Man with OCD, CBT and SSRI aren’t working, what would you do next?
A

Clomipramine

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46
Q
  1. 45 y/o man believes he is dead and does not exist. He says he feels miserable most of the time, and that his wife left him for another man 5 months ago. He has increased his alcohol intake and now has 3 pints of lager every day, and occasionally smokes cannabis. He has lost 7kg in weight over 3 months. What is the most likely diagnosis?
A

depression + psychosis

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47
Q
  1. Patient on anti-depressant has long QT on ECG. Which medication?
A

amitriptylline

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48
Q
  1. Woman (19 years old) on microgynon 30 who smokes a bit starts developing migraines w/o aura, what would you do? Keep her on it and offer smoking cessation, change to POP, continue and give sumitriptan
A

change to POP

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49
Q
  1. Rh negative, minor bleed at 9 weeks, resolves in 48 hours. What do you do? Nothing, Anti-D, Kleihauer
A

Nothing

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50
Q
  1. What would NSAID use in the last trimester lead to?
A

Closure of DA

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51
Q
  1. Woman after diagnostic laparoscopy had acute urinary retention which was treated and then had the catheter removed, when can she safely go home? When she has passed 200mls, when there is 100 mls post-void volume, when there is 20ml post-void volume…
A

100ml post void

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52
Q
  1. Woman planning to mix feed her baby after birth. When can she expect period to return? Within 6 weeks, within 6 months, can’t say, when she stops breastfeeding
A

6 weeks

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53
Q
  1. Lady with ectopic wants to know how long after methotrexate tx you can/should wait to get pregnant?
A

3 months

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54
Q
  1. Antenatal scan at 18-20 weeks? See echogenic bowel on ultrasound. What is the significance of this? Incidental finding, trisomy 21, trisomy 13
A

21

55
Q
  1. Lady in first trimester, vomiting lots, tried having cyclizine 50 mg once a day but it did not work. What should she try next? Increase cyclizine to three times a day, add PPI to treatment regime, prochlorpermazine
A

proclorpremazine

56
Q
  1. Woman had a dating scan at 12 weeks, foetal CRL equivalent to 9 weeks foetus but no heart beat. Mx? Counsel on miscarriage options, repeat scan in 7 days, serum b-hcg and repeat in 48 hours
A

repeat scan in 7 days

57
Q
  1. Photo of white lesion on labia, painful urination. Tx? Oral aciclovir, flucoxacillin, topical aciclovir
A

oral acyclovir

58
Q
  1. Pregnant woman has dysuria, frequency and urgency. Otherwise well. Mx plan? Reassure no treatment needed, send urine for MC&S and treat empirically with abx, send urine for MC&S and treat with abx based on results, treat empirically with abx without ix
A

treat and send mcs

59
Q
  1. Woman with 1+ protein on urine dipstick but normal blood pressure at 32 weeks. Mx? Immediate referral to obstetrics team, repeat urinalysis in one week, repeat urinalysis the next day
A

repeat in 1 week

60
Q
  1. Woman with severe pain due to fibroids in pregnancy. Opiate does not help. 32 weeks pregnant. Management? Continue opiate analgesia, epidural analgesia, NSAIDs, uterine artery embolization
A

opiate

61
Q
  1. 19 year old with post-coital bleeding for 3 weeks, had an implant inserted 18 months ago. Vaginal and speculum exam are normal. Pregnancy test negative. Next mx? Endocervical, chlyamydia and HVS, cervical cytology, TVUSS
A

swabs

62
Q
  1. Woman with dragging sensation in vagina when exercising. Weakened anterior vaginal wall but no descent to introitus on straining. Next mx? Pelvic floor exercises, refer to urogynae clinic, refer for urodynamics testing
A

pelvic floor

63
Q
  1. 60 year old woman with dyspareunia and vaginal dryness. Best mx? Oral HRT, transdermal HRT, topical vaginal oestrogens, vaginal lubricants
A

topical eostrogens

64
Q
  1. Baby born to a mother with SLE has bradycardia. What is the most likely diagnosis?
A

Congenital heart block

65
Q

rl weighing 100 kg, striae and darker skin in armpits and necks, feeling tired, has thrush. Fasting glucose is over 7 mmol/L (7.8). What pharmacological tx to try? Metformin

A

metformin

66
Q
  1. Man thinks bloke on TV is talking about him, what is this phenomenon known as? Delusion of reference
A

delusion of reference

67
Q
  1. Woman w dementia keeps leaving care home at 3:00, what legal provisions/ which legal act would you consider to stop this from happening?
A

Deprivation of liberty safeguard

68
Q
  1. 40 year old doctor with central chest pain but no abnormalities on ECG. Which drug is likely to be causing this?
A

cocaine

69
Q
  1. Man thinks his wife is cheating on him and he has been verifying this by checking her underwear (damn he nasty). What is the most likely diagnosis?
A

orthello syndrome

70
Q
  1. Woman has become blind after attending her mother’s funeral, does not seem to be concerned by the sudden onset of blindness. Physical exam and obs are normal. Most likely diagnosis?
A

Conversion disorder

71
Q
  1. Woman with schizophrenia describes experiences when she feels like she is not real. What phenomenon is this?
A

Depersonalisation

72
Q
  1. Man comes into the hospital/care home, and a few weeks later is confused. History of heavy alcohol use. Most likely diagnosis?
A

Korsakoff’s

73
Q

n comes to hospital 3 days ago for knee replacement surgery. Now complains of seeing ants crawling on him and has a tremor and confusion. What is the likely diagnosis?

A

Delirium tremenes

74
Q
  1. Probability of being permanently paralysed from epidural
A

1:20000

75
Q
  1. Pregnant woman at 28 weeks in GP. Normal antenatal scans. Has had influenza vaccine. What other vaccine does she need?
A

Pertussis

76
Q
  1. 25 y/o man attends A&E with headache. He is speaking rapidly and smiling as he talks. He scratches his skin constantly and claims to feel insects crawling up him. His temperature is 36.5, HR 130, and BP 154/84. What is the most likely diagnosis?
    a. Alcohol withdrawal
    b. Benzodiazepine withdrawal
    c. Cannabis intoxication
    d. Cocaine intoxication
    e. Heroin withdrawal
A

cocaine

77
Q
  1. 70 y/o woman known to community mental health team sees her GP with new onset tremor, painful muscle contractions, dry mouth, and weight gain. Which medication is likely to be causing her symptoms?
    a. Amitriptyline
    b. Levodopa
    c. Olanzapine
    d. Paroxetine
    e. Propranolol
A

olanzapine

78
Q
  1. 29 y/o woman with past history of cocaine and cannabis use denies using for the past 3 years. Which additional test should be done for this patient at booking?
    a. Hair toxicology screen
    b. Hepatitis C
    c. Hepatitis E
    d. Serum toxicology screen
    e. Urine toxicology screen
A

hepatitis c

79
Q
  1. 25 y/o woman who is 38 weeks pregnant is seen in triage for irregular painful contractions lasting 6 hours. She took paracetamol 6 hours ago. She is examined and found to be 2cm dilated. Which analgesia is most appropriate?
    a. Co-dydramol
    b. Epidural analgesia
    c. Nitrous oxide
    d. NSAID
    e. Warm bath
A

co-dydramol

80
Q
  1. 55 y/o woman in GP describes sudden need to urinate throughout the day with occasional leaks when she can’t make it to the bathroom in time. There is no dysuria and a urine dipstick is normal. What is the most appropriate management option?
    a. Bladder training
    b. Incontinence pads
    c. Pelvic floor exercises
    d. Tolterodine
    e. Trimethoprim
A

bladder retraining

81
Q

6 year old kid with Down’s syndrome with bilious vomiting and distended abdomen, patent anus - Hirschprung’s, duodenal atresia, volvulus?

A

volvulus

82
Q
  1. Difficult balance, cannot build block of towers, hyperreflexia (description of ataxic CP). Where is lesion
A

cerebellum

83
Q
  1. Young girl presenting to GP with hepatomegaly and petechiae across chest and arms, seems well
A

ALL

84
Q
  1. Young girl presenting to GP with hepatomegaly and petechiae across chest and arms, seems well
A

ALL

85
Q
  1. Child with mild croup symptoms comes into GP, RR of 65. What is your management
A

admit

86
Q

Boy on motorbike twists his testicle. What treatment?

A

exploratory laporotamy

87
Q

Kid with globally delayed milestones, started to walk at 18 months, saying 2 word phrases at 3 years, 50 word vocabulary at 3 years. What would be the most useful investigation?

A

mri
think CP as globally delayed

88
Q

Voraciously hungry kid, hypotonia and feeding difficulties as a neonate, and almond eyes what was the diagnosis?

A

prader wili

89
Q

Newborn with purple spot on face, what is the best approach

A

discharge to gp follow up

90
Q

Uncle gets TB, kid lives with him, Mantoux test showed a number between 10-14mm for the result. What should you do?

A

start on anti-TB

91
Q

Kid growing along the 55th centile and is vomiting after food. He was bottle and breast-fed. What is the cause?

A

GORD

92
Q

Kid with impaired taste stuff, then awareness and then goes to sleep for like an hour and back to normal. No memory of event

A

focal seizure

93
Q

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

A

repeat steroid

94
Q

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

A

conjugated bilirubin

95
Q

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

A

urine dip

96
Q

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?

A

gonadotrophin stimulation test

97
Q

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

A

first words and speech and language

98
Q

Child with fever, white exudate on one tonsil, diagnosis? Tonsillitis, Quinsy, diphtheria

A

tonsilitis

99
Q

Infant with episodes of throwing arms forward with fists clenched. Febrile seizure, focal seizure, Infantile spasms, partial seizure

A

infantile spasms

100
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? Chronic renal failure, diabetes mellitus, nephroblastoma, acute pyelonephritis, urinary tract infection

A

diabetes

101
Q

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

A

VSD

102
Q

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

A

infusion

103
Q

4 month old, about to have 3 batch of primary vaccinations. Which would be a complete contraindication to having the vaccine? Confirmed history of pertussis as a baby, currently ill with a fever of 38.5?, got a rash at site of last vaccination, severe cow’s milk allergy,

A

fever

104
Q

5 month old with cough, runny nose, fever. Examination of chest you hear wheeze. What’s the main pathogen that causes this RTI?

A

respiratory syncytial virus

105
Q

Unwell kid with indentable mass in left iliac fossa?

A

constipation

106
Q

Mother with cold sores has been kissing her child who has a background of eczema

A

eczema herpeticum

107
Q

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

A

meconium aspiration

108
Q

Baby born at 37 weeks, via forceps. Showing signs of resp distress. CXR shows areas of consolidation throughout

A

group B strep

109
Q

Scabies tx

A

permetrim

110
Q

Grandmother brings boy in with swollen knee. Boy’s brother died young of a minor head injury

A

haemophilia

111
Q

Kid who had rashes which had crusted over and he was also scratching them and now he had a fever and cool peripheries. What is the cause for his acute presentation?

A

bacterial infection

112
Q
  1. Woman had abdo trauma 32 weeks, had anti-D. Had her anti-D at 28 weeks – what to do next?
A

kleihauer + anti D

113
Q

Mother had rupture of membranes at 32 weeks but is not in labour. What do you give her?

A

erythromycin and steroids

114
Q

Woman had some intrauterine growth and endometrial thickness. What was the diagnosis

A

fibroids

115
Q

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

A

ivf

116
Q

HRT question for a menopausal woman with flushes, last period 10m ago. What do you give her?

A

cyclical HRT

117
Q

Girl with painful periods in the first 2 days of her period ever since menarche, she has heavy bleeding. What is it?

A

primary dysmenorrhoea

118
Q

Foetus with transverse lie, recent SROM, CTG shows fetal distress. Most likely cause?

A

umblical cord prolapse

119
Q

Foetus with transverse lie, recent SROM, CTG shows fetal distress. Most likely cause?

A

umblical cord prolapse

120
Q

Woman with painful breast after giving birth. She’s breast-feeding and has an abscess secondary to mastitis. Surgical excision, aspirate and culture, Ciprofloxacin

A

aspirate and culture

121
Q

Heavy periods in a girl not yet sexually active. What do you give her? COCP, mefenamic acid, tranexamic acid

A

tranexamic acid

122
Q

Woman 38/40 has come in for her elective C-section, ECV was attempted and failed, what do you do now? c/s at 39, 40 or 38 weeks, carry on with the C/S as planned

A

carry on w/ c/s

123
Q

Woman with high BMI (28) who basically had stress incontinence. What’s the first line management? Pelvic floor exercises , oxybutinin, bladder training, weight loss and lifestyle change?

A

pelvic floor

weight loss only recommended if BMI >30)

124
Q

Poorly controlled diabetic mother, her newborn has an abnormal asymmetric Moro reflex - what’s wrong?

A

brachial pelxus injury

125
Q

What do you measure at booking for hepatitis b?

A

hepatitis b surface antigen

126
Q

Man with azoospermia – what is the most likely cause?

A

varicocoele

127
Q

The very last question was a bunch of tests for a woman who couldn’t conceive- all test normal and prolactin raised by like 2 points above normal value what’s most likely cause? Unknown (accounts for 30% of subfertility), prolactinoma (prolactin would be in 1000s), raised testosterone suggests PCOS (LH:FSH ratio>2/3)

A

unknown

128
Q

Woman who is exclusively breastfeeding for 6 weeks and wants contraception

A

She can rely on breastfeeding as long as it is frequent, she is breastfeeding exclusively, and she will need other contraception by the 6 month mark

129
Q

Woman with offensive smelly lochia day 2 post-partum, had had some high vaginal swabs? Reassure and discharge, await swab results, give broad-spectrum antibiotics?, abdo USS

A

give broach spec

130
Q

What signifies onset of active/ established labour?

A

> = 4cm cervix dilated

131
Q

Woman with Nexplanon. Most likely reason for wanting to change contraceptive? Weight gain, acne, mood swings, irregular bleeding

A

irregular bleeding

132
Q
  1. What causes increased urinary volume and frequency in the first trimester? Increased GFR, pressure of uterus on bladder, glycosuria
A

inc GFR

133
Q

Effect of taking Paroxetine during pregnancy on baby?

A

In first trimester: small risk of congenital heart defects. In third trimester: risk of persistent pulmonary hypertension of the newborn

134
Q

UTI in first trimester of pregnancy. What would be the safest and most effective treatment? Trimethoprim, Ciprofloxacin, Doxycycline, Cefalexin, Meropenem

A

cefalexin

135
Q

Lady with cyclic pain 1 week before her period starts, trying for a baby for one year Diagnosis? ovarian cyst, endometriosis

A

endometritis

136
Q

painful lump isnide vagina
painless lump slowly

A

vulval cancer
bartholins cyst

137
Q

11 y/o girl in GP with nausea, vomiting, headaches, and loss of appetite. School say she is starting to lag behind in class and has attended the school nurse regularly with playground falls. She is a healthy weight and has no focal neurology. What is the most appropriate next step?
a. Immediately discuss with on call paediatrician
b. Reassure and review in 4 weeks
c. Refer for a non-urgent MRI brain scan
d. Refer to neurologist under 2 week wait

A

immediately discuss

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