PPQs Flashcards
Total abdo Hysterectomy yesterday. Woman goes upstairs and faints. Normal BP. DX
Hypovolaemic shock
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
G4 P2+1
Lady who had a tear after delivering baby, a few days later has offensive discharge, no fever or other symptoms (last VSA of paper)
Infection of perineal wound
Girl with dyskaryosis has colposcopy and biopsy showing CIN1. When should next colposcopy be? 2 weeks?, 1 month?
12 months
30 yr woman with last menstrual period on 25th August, 31 days cycles. What is the EDD
June 4
Woman wants to terminate her 8 week pregnancy because she already has 3 children - which clause of the abortion act does this fall under?
D
45F. Wertheim’s hysterectomy. Last cervical smear 2 years ago. When next smear? 1 year?, no smears needed
no smears
Hysterectomy yesterday. How long to stay off work for: 48h/1w/4w/3 months
4 weeks
- 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..
continue
- Which test for Down syndrome screening at 15 weeks? Amniocentesis, NIPT (think its this as this was the only SCREEN), CVS
NIPT
Woman had a 3B tear previously, what mode of delivery for current pregnancy?
Vaginal
- 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
episiotomy on day
Woman gets headache 24hrs after delivery?? Post-dural headache, pre-eclampsia, migraines, cerebral vein thrombosis
migraine
Loss of libido. DHx COCP Cetirizine Salbutamol inhaler. What is the cause of loss of libido? Stress?
cetirizine
Test to do in woman who is scantily dressed, irritated,
TFTs
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?
10%
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
depression
Girl witnesses car crash and goes few hours later blind. Dissociative disorder? Acute stress reaction? Conversion disorder
acute stress reaction
Guy prescribed citalopram, name one possible side effect he should be told about?
low libido
Woman with dementia, which part of brain is likely to be affected early?
Hippocampus
Woman believes celebrity is her lover and writers letters to him. Then stalks him
Eratomania
Man with hyper-reflexia and tremor, what drug
Lithium
3 year old girl with tiredness and snoring, and frequent coughs and colds, and speech was normal but difficulty articulating words. What Ix
hearing test, karyotyping for downs?
On newborn check, inverted ankles and plantar flexed, what sign is this?
talipes equinovarus
5 year old kid with headache and bed wetting, low end of normal specific gravity
cranial DI
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
GP give oral dex and review
How should you give influenza vaccine to kid who is allergic to eggs, cow’s milk protein….? in hospital IM injection, in GP, etc..
GP
4hr old new born baby has raised respiratory rate, everything else is normal
TTN
Maternal T1DM increases risk of what condition in newborn? Neural tube defects, hydronephrosis, gastrochisis, omphalocele, congenital diaphragmatic hernia
neural tube defects
Maintenance fluid to give to kid with diabetes mellitus - 0.9% saline, 0.9% saline with 5% dextrose, 0.9% saline with 4% dextrose
0.9% saline
- 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
anytime
- Kid from Pakistan whose parents are first cousins has acute respiratory failure and pneumocystis pneumonia, what dx? SCID, agammaglobulinemia, HIV, cystic fibrosis
SCID
- Neonate with fever, sunken fontanelle and reduced right leg movement, most likely dx? Osteomyelitis, NAI, sepsis
osteomyelitis
- 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
physiological delay
- 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
turner’s
- Raised conj bili in a 3w old kid, what would you do next? Phototherapy, outpatient USS, inpatient USS
inpatient USS
- 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
temper tantrums
- 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
none
- 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
autism
- Child with bruises all over knees after being able to walk, some swelling in knee joint. Dx?
Haemophilia
- Adolescent with 6m or so of depression symptoms, what’s the next step in management? CBT, family therapy, sertraline, fluoxetine
CBT
- Man with OCD, CBT and SSRI aren’t working, what would you do next? Clomipramine
- Man with OCD, CBT and SSRI aren’t working, what would you do next? Clomipramine
- Man with OCD, CBT and SSRI aren’t working, what would you do next? Clomipramine
- Man with OCD, CBT and SSRI aren’t working, what would you do next? Clomipramine
- Man with OCD, CBT and SSRI aren’t working, what would you do next? Clomipramine
- Man with OCD, CBT and SSRI aren’t working, what would you do next?
Clomipramine
- 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?
depression + psychosis
- Patient on anti-depressant has long QT on ECG. Which medication?
amitriptylline
- 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
change to POP
- Rh negative, minor bleed at 9 weeks, resolves in 48 hours. What do you do? Nothing, Anti-D, Kleihauer
Nothing
- What would NSAID use in the last trimester lead to?
Closure of DA
- 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…
100ml post void
- 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
6 weeks
- Lady with ectopic wants to know how long after methotrexate tx you can/should wait to get pregnant?
3 months
- Antenatal scan at 18-20 weeks? See echogenic bowel on ultrasound. What is the significance of this? Incidental finding, trisomy 21, trisomy 13
21
- 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
proclorpremazine
- 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
repeat scan in 7 days
- Photo of white lesion on labia, painful urination. Tx? Oral aciclovir, flucoxacillin, topical aciclovir
oral acyclovir
- 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
treat and send mcs
- 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
repeat in 1 week
- 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
opiate
- 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
swabs
- 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
pelvic floor
- 60 year old woman with dyspareunia and vaginal dryness. Best mx? Oral HRT, transdermal HRT, topical vaginal oestrogens, vaginal lubricants
topical eostrogens
- Baby born to a mother with SLE has bradycardia. What is the most likely diagnosis?
Congenital heart block
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
metformin
- Man thinks bloke on TV is talking about him, what is this phenomenon known as? Delusion of reference
delusion of reference
- Woman w dementia keeps leaving care home at 3:00, what legal provisions/ which legal act would you consider to stop this from happening?
Deprivation of liberty safeguard
- 40 year old doctor with central chest pain but no abnormalities on ECG. Which drug is likely to be causing this?
cocaine
- 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?
orthello syndrome
- 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?
Conversion disorder
- Woman with schizophrenia describes experiences when she feels like she is not real. What phenomenon is this?
Depersonalisation
- Man comes into the hospital/care home, and a few weeks later is confused. History of heavy alcohol use. Most likely diagnosis?
Korsakoff’s
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?
Delirium tremenes
- Probability of being permanently paralysed from epidural
1:20000
- Pregnant woman at 28 weeks in GP. Normal antenatal scans. Has had influenza vaccine. What other vaccine does she need?
Pertussis
- 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
cocaine
- 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
olanzapine
- 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
hepatitis c
- 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
co-dydramol
- 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
bladder retraining
6 year old kid with Down’s syndrome with bilious vomiting and distended abdomen, patent anus - Hirschprung’s, duodenal atresia, volvulus?
volvulus
- Difficult balance, cannot build block of towers, hyperreflexia (description of ataxic CP). Where is lesion
cerebellum
- Young girl presenting to GP with hepatomegaly and petechiae across chest and arms, seems well
ALL
- Young girl presenting to GP with hepatomegaly and petechiae across chest and arms, seems well
ALL
- Child with mild croup symptoms comes into GP, RR of 65. What is your management
admit
Boy on motorbike twists his testicle. What treatment?
exploratory laporotamy
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?
mri
think CP as globally delayed
Voraciously hungry kid, hypotonia and feeding difficulties as a neonate, and almond eyes what was the diagnosis?
prader wili
Newborn with purple spot on face, what is the best approach
discharge to gp follow up
Uncle gets TB, kid lives with him, Mantoux test showed a number between 10-14mm for the result. What should you do?
start on anti-TB
Kid growing along the 55th centile and is vomiting after food. He was bottle and breast-fed. What is the cause?
GORD
Kid with impaired taste stuff, then awareness and then goes to sleep for like an hour and back to normal. No memory of event
focal seizure
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
repeat steroid
Kid with yellow and grey stools and was like 4 weeks old or something. What do you test for?
conjugated bilirubin
Another case with an unwell child where chest was clear, had a fever. Lost weight recently. What do you do next?
urine dip
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?
gonadotrophin stimulation test
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
first words and speech and language
Child with fever, white exudate on one tonsil, diagnosis? Tonsillitis, Quinsy, diphtheria
tonsilitis
Infant with episodes of throwing arms forward with fists clenched. Febrile seizure, focal seizure, Infantile spasms, partial seizure
infantile spasms
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
diabetes
3 months old baby with signs of HF, systolic murmur that radiates over the praecordium -
VSD
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
infusion
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,
fever
5 month old with cough, runny nose, fever. Examination of chest you hear wheeze. What’s the main pathogen that causes this RTI?
respiratory syncytial virus
Unwell kid with indentable mass in left iliac fossa?
constipation
Mother with cold sores has been kissing her child who has a background of eczema
eczema herpeticum
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
meconium aspiration
Baby born at 37 weeks, via forceps. Showing signs of resp distress. CXR shows areas of consolidation throughout
group B strep
Scabies tx
permetrim
Grandmother brings boy in with swollen knee. Boy’s brother died young of a minor head injury
haemophilia
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?
bacterial infection
- Woman had abdo trauma 32 weeks, had anti-D. Had her anti-D at 28 weeks – what to do next?
kleihauer + anti D
Mother had rupture of membranes at 32 weeks but is not in labour. What do you give her?
erythromycin and steroids
Woman had some intrauterine growth and endometrial thickness. What was the diagnosis
fibroids
Woman with blocked tubes on hysterosalpingogram, what treatment should you do for fertility
ivf
HRT question for a menopausal woman with flushes, last period 10m ago. What do you give her?
cyclical HRT
Girl with painful periods in the first 2 days of her period ever since menarche, she has heavy bleeding. What is it?
primary dysmenorrhoea
Foetus with transverse lie, recent SROM, CTG shows fetal distress. Most likely cause?
umblical cord prolapse
Foetus with transverse lie, recent SROM, CTG shows fetal distress. Most likely cause?
umblical cord prolapse
Woman with painful breast after giving birth. She’s breast-feeding and has an abscess secondary to mastitis. Surgical excision, aspirate and culture, Ciprofloxacin
aspirate and culture
Heavy periods in a girl not yet sexually active. What do you give her? COCP, mefenamic acid, tranexamic acid
tranexamic acid
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
carry on w/ c/s
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?
pelvic floor
weight loss only recommended if BMI >30)
Poorly controlled diabetic mother, her newborn has an abnormal asymmetric Moro reflex - what’s wrong?
brachial pelxus injury
What do you measure at booking for hepatitis b?
hepatitis b surface antigen
Man with azoospermia – what is the most likely cause?
varicocoele
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)
unknown
Woman who is exclusively breastfeeding for 6 weeks and wants contraception
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
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
give broach spec
What signifies onset of active/ established labour?
> = 4cm cervix dilated
Woman with Nexplanon. Most likely reason for wanting to change contraceptive? Weight gain, acne, mood swings, irregular bleeding
irregular bleeding
- What causes increased urinary volume and frequency in the first trimester? Increased GFR, pressure of uterus on bladder, glycosuria
inc GFR
Effect of taking Paroxetine during pregnancy on baby?
In first trimester: small risk of congenital heart defects. In third trimester: risk of persistent pulmonary hypertension of the newborn
UTI in first trimester of pregnancy. What would be the safest and most effective treatment? Trimethoprim, Ciprofloxacin, Doxycycline, Cefalexin, Meropenem
cefalexin
Lady with cyclic pain 1 week before her period starts, trying for a baby for one year Diagnosis? ovarian cyst, endometriosis
endometritis
painful lump isnide vagina
painless lump slowly
vulval cancer
bartholins cyst
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
immediately discuss
